GastroEast Physicians, Louisville, KY

Peptic Ulcer Disease

Peptic ulcer disease (PUD) is a serious disorder which affects the stomach or small intestine, particularly the duodenum or upper small intestine. Ulcers are erosions or crater like disruptions of the lining of the stomach or duodenum. These disruptions can be life threatening if a perforation (a full thickness tear of the stomach or duodenum) or GI bleeding were to occur.

Usually signs and symptoms of PUD are mild and point to the diagnosis, these are as follows:

1) Nausea
2) Vomiting
3) Pain in the midepigastric region (above the belly button)
4) Early satiety (early sense of fullness after consuming a small amount of food)
5) Lack of appetite with weight loss.
6) Black tarry stools point to bleeding from PUD
7) Vomiting of blood points to a large bleed from an ulcer and a visit to an emergency room immediately is necessary.

Causes of PUD
PUD is caused by a disruption in the lining of the GI tract. This occurs by 2 mechanisms; medications and bacterial infection. Although popular theory for many years, but disproved recently, every day stress and certain types of food do not cause ulcers.
The most common medications which cause damage to the stomach or duodenum are aspirin and NSAIDs. Any form of aspirin, even enteric coated or low dose 81 mg can cause ulcers. Similarly, any form of NSAIDs such as Ibuprofen, Naprosyn, Alleve, Advil, BC or Goody powders, even Celebrex can cause damage to the GI tract resulting in ulcer formation.

Another cause of PUD is H. Pylori infection (Helicobacter Pylori). This is a bacterium which can be found in the stomach and can cause a disruption in the protective mechanisms of the stomach lining. If the protective mechanism of the stomach lining is disrupted, stomach acid runs rampant, and ulcers can form. Eradication of the bacteria with antibiotics usually will cure the ulcers if H. pylori bacteria are the cause.

Another factor is cigarette smoking, which increases the risk of developing ulcers, and prevents ulcer healing.

Diagnostic testing
If a patient has any of the symptoms described above, a visit to a physician is necessary. After a complete medical history is obtained and a physical exam is performed, diagnostic testing will be performed to detect the presence of PUD.
The most common test performed is EGD or upper endoscopy. A lighted tube with a camera on the end is placed in the stomach then into the duodenum to look for ulcers. If ulcers are found, treatment can be initiated to heal the ulcers. At the time of EGD, H. pylori infection can be diagnosed. This is done by biopsying or obtaining tissue from the lining of the stomach to search for the bacteria under the microscope. Alternatively, doctors can look for the bacteria by doing blood tests, breath tests, and stool tests.
Most ulcers can be healed with medications. Surgery is rarely needed except when complications such as perforation or massive uncontrolled bleeding has occurred.

Treatment
Treatment involves stopping all aspirin or NSAIDs.
If H. Pylori infection is present, the bacteria will attempt to be eradicated via antibiotic (2 week course) and PPI treatment. PPI treatment(omeprazole, lansoprazole, pantoprazole, etc) will usually be initiated twice a day for 2 weeks to eradicate the bacteria. The treatment will be continued for 6 weeks more, if an ulcer exists with the bacteria infection.

After the 8 to 12 week course of PPI treatment, a repeat EGD will be ordered to confirm stomach ulcer healing and eradication. Very rarely, stomach ulcers contain a small focus of cancer; this is why a repeat EGD is done. If cancer does exist around the ulcer, simple medical treatment will not cure the ulcer/cancer.

Duodenal ulcers only require treatment, and a repeat EGD is not necessary to check ulcer healing, unless symptoms continue after treatment. Duodenal cancer and PUD do not coexist, therefore a re-look EGD is not necessary.

Smoking should be eliminated and alcohol use should be discontinued. Usually, small amounts of alcohol will be allowed again after the ulcers have healed.