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INTRODUCTION
I. DEFINITION:
Peptic ulcer disease (PUD), also known as a peptic ulcer, is a break in the lining of
the stomach, first part of the small intestine, or occasionally the lower esophagus. An ulcer in the
stomach is known as a gastric ulcer while that in the first part of the intestines is known as
a duodenal ulcer.1
II. CAUSES:
1. Helicobacter pylori
A major causative factor (60% of gastric and up to 5075%of duodenal ulcers) is
chronic inflammation due to Helicobacter pylori that colonizes the antral mucosa. The immune
system is unable to clear the infection, despite the appearance of antibodies. Thus, the bacterium
can cause a chronic active gastritis (type B gastritis). Gastrin stimulates the production of gastric
acid by parietal cells. In H. pylori colonization, responses to increased gastrin, the increase in acid
can contribute to the erosion of the mucosa and therefore ulcer formation. 2
3. Stress
Stress due to serious health problems such as those requiring treatment in an intensive
care unit is well described as a cause of peptic ulcers, which are termed stress ulcers.
While chronic life stress was once believed to be the main cause of ulcers, this is no
longer the case. It is, however, still occasionally believed to play a role. This may be by
increasing the risk in those with other causes such as H. pylori or NSAID use.3
4. Diet
Dietary factors such as spice consumption were hypothesized to cause ulcers until late in
the 20th century, but have been shown to be of relatively minor importance. Caffeine and coffee,
also commonly thought to cause or exacerbate ulcers, appear to have little effect. Similarly, while
studies have found that alcohol consumption increases risk when associated with H.
pylori infection, it does not seem to independently increase risk. Even when coupled with H.
pylori infection, the increase is modest in comparison to the primary risk factor. 4
1. 1
"Definition and Facts for Peptic Ulcer Disease". National Institute of Diabetes and
Digestive and Kidney Diseases.
2. http://www.niddk.nih.gov/health-information/digestive-diseases/peptic.
Retrieved 11 April 2017.
3. 2
"Antral mucosa - Humpath.com - Human pathology". Archived from the original on
2011-11-09.
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5. Other cause
A rare condition known as Zollinger-Ellison syndrome can cause gastric and
duodenal ulcers. This condition causes cancerous and noncancerous tumors to develop in
the stomach and duodenum. 5
The following are the factors that may cause peptic ulcer disease: 6
While doctors often recommend NSAIDs for health conditions such as arthritis or
joint inflammation, NSAIDs can increase your risk for developing peptic ulcers.
Additional medications that may increase your risk for gastric and duodenal ulcers
include:
alendronate (Fosamax)
Anticoagulants
risedronate (Actonel)
selective serotonin reuptake inhibitors (SSRIs)
Spicy foods dont increase your risk for ulcers but they can irritate your stomach
further.
Other risk factors known to increase your risk for developing gastric and duodenal
ulcers include:
being 70 years old or older
drinking alcohol
history of peptic ulcers
smoking
Signs and symptoms of a peptic ulcer can include one or more of the following: 7
Abdominal pain, classically epigastric strongly correlated to mealtimes. In case of
duodenal ulcers the pain appears about three hours after taking a meal;
Bloating and abdominal fullness;
Waterbrash (rush of saliva after an episode of regurgitation to dilute the acid in
esophagus - although this is more associated with gastroesophageal reflux disease);
Nausea, and copious vomiting;
Loss of appetite and weight loss;
Hematemesis (vomiting of blood); this can occur due to bleeding directly from a
gastric ulcer, or from damage to the esophagus from severe/continuing vomiting.
Melena (tarry, foul-smelling feces due to presence of oxidized iron
from hemoglobin);
Rarely, an ulcer can lead to a gastric or duodenal perforation, which leads to acute
peritonitis, extreme, stabbing pain, and requires immediate surgery. 8
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5
All about Peptic Ulcer Disease.
A history of heartburn, gastroesophageal reflux disease (GERD) and use of certain
http://www.merckmanuals.com/professional/gastrointestinal-
forms disorders/gastritis-and-peptic-ulcer-disease.
of medication can raise the suspicion for Retrieved 11 April
peptic ulcer. 2017
Medicines associated with
6
"Peptic Ulcer". Home Health Handbook for Patients & Caregivers. Merck Manuals. October
peptic
2006. ulcer include NSAIDs (non-steroid anti-inflammatory drugs) that
1. inhibit cyclooxygenase,
7
and most glucocorticoids
"Stomach ulcer Signs and9
(eg. prednisolone). Symptoms.
http://www.nhs.uk/Conditions/peptic-ulcer/Pages/causes.aspx
In patients over 45 with more than two weeks of the above symptoms, the odds
2. 8
"Ulcer: Facts and Myths". http://www.diseaseulceration.net. Retrieved 12
for peptic
April 2017 ulceration are high enough to warrant rapid investigation by esophagogastro
2. duodenoscopy (EGD).
The timing of the symptoms in relation to the meal may differentiate between
gastric and duodenal ulcers: A gastric ulcer would give epigastric pain during the meal,
as gastric acid production is increased as food enters the stomach. Symptoms of duodenal
ulcers would initially be relieved by a meal, as the pyloric sphincter closes to concentrate
the stomach contents; therefore acid is not reaching the duodenum. Duodenal ulcer pain
would manifest mostly 23 hours after the meal, when the stomach begins to release
digested food and acid into the duodenum. 9
Also, the symptoms of peptic ulcers may vary with the location of the ulcer and
the patient's age. Furthermore, typical ulcers tend to heal and recur and as a result the
pain may occur for few days and weeks and then wane or disappear. Usually, children
and the elderly do not develop any symptoms unless complications have arisen. 9
Burning or gnawing feeling in the stomach area lasting between 30 minutes and
3 hours commonly accompanies ulcers. This pain can be misinterpreted
as hunger, indigestion or heartburn. Pain is usually caused by the ulcer but it may be
aggravated by the stomach acid when it comes into contact with the ulcerated area. The
pain caused by peptic ulcers can be felt anywhere from the navel up to the sternum, it
may last from few minutes to several hours and it may be worse when the stomach is
empty. Also, sometimes the pain may flare at night and it can commonly be temporarily
relieved by eating foods that buffer stomach acid or by taking anti-acid medication.
However, peptic ulcer disease symptoms may be different for every sufferer. 9
VI. TREATMENTS:
The following are treatments given to patients with PUD: 12
Younger patients with ulcer-like symptoms are often treated with antacids or H2
antagonists before endoscopy is undertaken.
People who are taking nonsteroidal anti-inflammatories (NSAIDs) may also be
prescribed a prostaglandin analogue (misoprostol) in order to help prevent peptic
ulcers.
Some are prescribed with H2 antagonists or proton-pump inhibitors which
10
"Stomach ulcer Tests and Diagnostics. http://www.nhs.uk/peptic-ulcer/Pages/tests. Retrieved 11
decrease the amount of acid in the stomach, helping with the healing of ulcers.
April 2017
5. 11
"PUD: How do you know you have it?". http://www.pepticulcerdisease.net.
Retrieved 12 April 2017
12
"Stomach ulcer Treatments. http://www.nhs.uk/peptic-ulcer/Pages/treatments.
Retrieved 11 April 2017
4.
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VII. COMPLICATIONS:
Gastrointestinal bleeding is the most common complication. Sudden large
bleeding can be life-threatening. It occurs when the ulcer erodes one of the blood
vessels, such as the gastroduodenal artery.
Perforation (a hole in the wall of the gastrointestinal tract) often leads to
catastrophic consequences if left untreated. Erosion of the gastro-intestinal wall
by the ulcer leads to spillage of stomach or intestinal content into the abdominal
cavity. Perforation at the anterior surface of the stomach leads to acute peritonitis,
initially chemical and later bacterial peritonitis. The first sign is often sudden
intense abdominal pain; an example is Valentino's syndrome, named after the
silent-film actor who experienced this pain before his death. Posterior wall
perforation leads to bleeding due to the involvement of gastroduodenal artery that
lies posterior to the first part of the duodenum.
Penetration is a form of perforation in which the hole leads to and the ulcer
continues into adjacent organs such as the liver and pancreas.
Gastric outlet obstruction is a narrowing of the pyloric canal by scarring and
swelling of the gastric antrum and duodenum due to peptic ulcers. The person
often presents with severe vomiting without bile.
Cancer is included in the differential diagnosis (elucidated
by biopsy), Helicobacter pylori as the etiological factor making it 3 to 6 times
more likely to develop stomach cancer from the ulcer.13
VIII. PREVENTIONS:
You can reduce your risk for ulcers by lowering your intake of NSAIDs or
switching to another medication, if youre taking NSAIDs.
Other methods for prevention include: 14
Take NSAIDs with meals or medications that protect your stomach lining, if you
need NSAIDs.
Avoid or limit caffeinated drinks and alcohol. They may worsen your symptoms.
Refrain from smoking, as it can slow healing.
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Take all of your antibiotics, if prescribed, for H. pylori infections. Not taking the
entire amount can bring the infection back.
Take steps to reduce the stress in your life. From sleeping more to taking time to
do something
13 you enjoy (reading,
"Stomach ulcer exercising,
or writing in a journal),
Complications. reducing
http://www.nhs.uk/peptic-
stress can keep gastric
ulcer/Pages/complications. and
Retrieved duodenal ulcer
11 April 2017 symptoms from getting worse.
14
Hole: Peptic Ulcer Disease. http://www.thepepticproject.com/peptic-ulcer-disease.
Retrieved 11 April 2017
IX. EPIDEMIOLOGY:
5. The three most deadly digestive diseases in Philippines during 2013 were peptic
ulcer disease, pancreatitis, and paralytic ileus and intestinal obstruction respectively. 13
10. The annual mortality rate per 100,000 people from peptic ulcer disease in
6. Philippines has decreased by 12.9% since 1990, and this has been shown to decrease in
an average of 0.6% a year. 13
For men, the deadliness of peptic ulcer disease in Philippines peaks at age 80+. It
kills men at the lowest rate at age 5-9. At 341.5 deaths per 100,000 men in 2013, the peak
mortality rate for men was higher than that of women, which was 202 per 100,000
women. Women are killed at the highest rate from peptic ulcer disease in Philippines at
age 80+. It was least deadly to women at age 5-9. 13
According to the latest WHO data published in may 2014, Peptic Ulcer Disease
deaths in Philippines reached 6,234 or 1.20% of total deaths in the said year. The age
adjusted death rate is 10.98 per 100,000 of population. 14
11. 13
Health Grove. http://global-disease-burden.healthgrove.com/Peptic-Ulcer-Disease-
in-Philippines. Retrieved 10 May 2017
12. 14
"World Health Rankings. http://www.worldlifeexpectancy.com/philippines-peptic-
ulcer-disease. Retrieved 10 May 2017
13.
14.
7.
15.