A treatise On Ulcers

Peptic ulcers (gastric and duodenal) are defects in the gastrointestinal mucosa that extend through the muscularis mucosa. Ulcer results when the balance between the aggressive forces (Helicobacter pylori, acid, pepsin, bile, drugs) and the mucosa defense: (microcirculation, Prostaglandins, apical cell restitution, hydrophobicity, HCO3, genetic) is disrupted. In the USA, the lifetime prevalence is 10% and for men it is 12% and 9% for women.

The one point prevalence for new PUD is 2% and duodenal ulcer occurs five times more than gastric ulcer. To differentiate gastric from duodenal ulcer, gastric ulcer is uncommon before 40 years, the pain is often increased by eating food and relieved by fasting. The acid secretion is normal, there is possibility of weight loss and hematemesis i.e. blood in the vomitus may occur.

In the case of duodenal ulcer, most occur between 25 and 75 years of age and pain is usually temporarily relieved by food intake and antacids, the pain is often nocturnal and there is acid hyper secretion, there is no associated weight loss and blood may be present in the stool.

Other factors implicated as theory of the aetiologic of ulcer include smoking, Calcium, Alcohol, Caffeine, Red pepper. The genetic theory implicates familial cluster ring. Other possible etiologies are Blood group O, AB (H) antigen, pepsinogen, HLA B5, Rheumatoid arthritis,COPD, Liver cirrhosis, CRF, renal transplantation, Herpes simplex, CMV, Hyperparathyroidism, Mastocytosis.Sex hormones and psychological factors may also play some minor role.

Clinical presentation of PUD may be 1) asymptomatic or 2) Symptoms may vary.  A high index of suspicion is therefore needed .It is more likely if: there is    Pain,    Anemia, heavy smoking,   Use of NSAIDs (non steroidal anti-inflammatory drugs.

The cardinal symptoms are nocturnal pain, as well as epigastric pain relieved by food and vomiting. And the signs include -The pointing sign in 70% -commonest, epigastric tenderness or discomfort only. Signs of outlet obstruction can also be elicited and also signs of other complications.

Treatment includes the use of Proton pump inhibitors include lansoprazole and omeprazole. They are remarkably safe drugs which have so far been used only to treat ulcers and other conditions where there is excess gastric acidity

In conclusion, one should therefore visit his or her doctor ones there is abdominal pain and the person has recurrent and refractory symptoms, the patient is more than 40 years old or has a family history of ulcer or the risk factors mentioned above are present in alarming proportions.

References

Elsevier (2009, April 24). Commonly Used Ulcer Drugs May Offer Treatment Potential In Alzheimer’s Disease. ScienceDaily. Retrieved May 1, 2009, from http://www.sciencedaily.com­ /releases/2009/04/090422103556.ht

Uppsala University (2008, May 9). Nitrates In Vegetables Protect Against Gastric Ulcers, Study Shows. ScienceDaily. Retrieved May 1, 2009, from http://www.sciencedaily.com­ /releases/2008/05/080507105601.ht