Peptic Ulcer

Peptic ulcer, also known as peptic ulcer disease (PUD), is caused by stomach acid and gastric juices eroding the gastrointestinal mucosa. The ulcer usually originates in the duodenum (first part of the small intestine), esophagus (muscular tube from throat to stomach), or stomach regions. Duodenal ulcers and gastric ulcers are two main types of peptic ulcers. Among them, duodenal ulcers are most common. They principally arise on duodenal bulb (first part of duodenum). Gastric ulcers that occur anywhere in stomach are usually benign and are more contrived by female patients than seen in male patients. Recent research studies reveal the spiral-shaped bacterium Helicobacter pylori as the most important cause of peptic ulcers. However, not everyone with this bacterium suffer from peptic ulcers. Other factors such as gastric tumor, overdose of aspirin, tobacco smoking, Zollinger-Ellison syndrome, and stress also contribute in the setting of for PUD. Typically, a peptic ulcer begins as a sore or erosion in the wall of the gastrointestinal tract. This, however, leads to an ultimate breakdown of tissue which causes severe burning pain in the abdomen.

One in 10 people in the United States suffer from an ulcer and approximately 500,000 new ulcer cases occur every year. Among them, patients between ages 30 and 55 are most susceptible to duodenal ulcers, while patients between ages 55 and 70 are at risk of developing gastric ulcers. Double the number of men is affected by duodenal ulcer than women. Most peptic ulcers are idiopathic in nature and about 10 percent of patients suffer from upper gastrointestinal tract bleeding. More often, bleeding will stop spontaneously; however, in some patients, it could be severe. Although ulcers can occur at any age, they are rare in young patients and mortality rate is higher in elderly patients. A key symptom indicating peptic ulcer disease in these patients is a bright red, coffee ground-like blood in the vomitus. This condition is known as hematemesis. Blood passed into the patient's feces gives rise to a condition known as melaena (black stool with foul smell).

One might have an ulcer and may still not experience any kind of symptoms. However, abdominal pain associated with indigestion in upper middle part or lower chest region is often observed. Usual symptoms for PUD includes abdominal pain with bloating and abdominal fullness, nausea, vomiting, loss of weight and appetite, and feces with foul smell. Occasionally, an ulcer might create a duodenal or gastric puncture that leads to bleeding. Surgery will be an option under this rare situation. Although clinically capricious, in general, symptoms with epigastric (upper middle part of abdomen) pain during mealtimes play a significant role in distinguishing duodenal ulcers from gastric ulcers. A warning sign for duodenal ulcer is visible before meal when the patient experiences a hunger attack due to acid production. This pain is alleviated by ingestion of food.

Contrary to the duodenal ulcers, an ulcer indicating a gastric region is worsened after a meal, due to intake of food that leads to gastric acid secretion and reflux of alkaline duodenal contents into the stomach. While H. pylori infection is a major cause of PUD, stress also has been associated and is now gaining recognition by researchers as a possible cause. This possibility takes a strong position as most people with H. pylori infection do not necessarily suffer from an ulcer. At present, researchers believe that ulcers result from a combined effect of both psychological stress and bacterial infection. While it is unknown at present to what extend stress actually creates risk for contriving an ulcer, researchers propose that unraveling the mystery will be a notable breakthrough for both clinical psychology and pathology of PUD.

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