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CONTENTS
INTRODUCTION ........................................................................................... 3
CAUSES .......................................................................................................... 4
SYMPTOMS .................................................................................................... 6
DIAGNOSIS .................................................................................................... 7
COMPLICATION ........................................................................................... 8
TREATMENT ................................................................................................. 10
PREVENTION................................................................................................. 13

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I. INTRODUCTION
Peptic ulcers are a relatively common disease in our country and shows signs of
increase due to lifestyles and daily living habits. Let's dive into the knowledge we
should know about this pathology to best prevent and support treatment.
What are peptic ulcers?
Peptic ulcers are sores that develop in the lining of the stomach, lower esophagus,
or small intestine. They’re usually formed as a result of inflammation caused by
the bacteria H. pylori, as well as from erosion from stomach acid.
There are three types of peptic ulcers:
 Gastric ulcer: ulcers that develop inside the stomach
 Esophageal ulcer: ulcers that develop inside the esophagus
 Duodenal ulcer: ulcers that develop in the upper section of the small
intestines, called the duodenum.
Peptic ulcers are a fairly common health problem.
Peptic ulcers are present in around 4% of the population.
According to the American Association of Gastroenterology, a survey of 4
million people with gastric ulcer and one in ten will have it for life.
According to the Vietnam Association of Gastroenterology, up to 70% of
Vietnamese are at risk of developing stomach ulcers.

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II. CAUSES
Peptic ulcers occur when acid in the digestive tract eats away at the inner surface
of the stomach or small intestine. The acid can create a painful open sore that may
bleed.
Your digestive tract is coated with a mucous layer that normally protects against
acid. But if the amount of acid is increased or the amount of mucus is decreased,
you could develop an ulcer.
Different causes can lead to break down the lining of stomach, the esophagus and
the small intestine:
Common causes include:
 Helicobacter pylori (H. pylori). More than 50% of the world’s population
can have H. pylori, most people infected with H. pylori don’t get ulcers.
But in others, it can raise the amount of acid, break down the protective
mucus layer, and irritate the digestive tract. These effects can cause
inflammation of the stomach's inner layer, producing an ulcer
 NSAIDs. Non-steroidal anti-inflammatory drugs (NSAIDs) are medicines
widely used to treat pain, fever and inflammation (swelling). These
medications include: Ibuprofen, Naproxen, Diclofenac, Aspirin. NSAIDs
work by reducing or blocking the production of certain body chemicals
(such as COX enzymes) that cause inflammation. They also inhibit
stomach mucosa cells secretion and mucosal blood flow so they can irritate
or inflame the lining of your stomach and small intestine.
Risk factors: In addition to common causes, you may have increased risks
of peptic ulcers such as:
 Smoking may increase the risk of peptic ulcers in people infected with H.
pylori.
 Drink too much alcohol and caffeine can irritate and erode the mucous
lining of your stomach, and it increases the amount of stomach acid that's
produced.
 Excess stress, especially prolonged stress, can have an effect on stomach
acid production. It can trigger an increased release of stomach acid and
raise inflammation.

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III. SYMPTOMS
Peptic ulcer disease has many symptoms so it can sometimes be mistaken for
others. But the most common symptom of peptic ulcers is abdominal pain. It
includes the following expressions:
• The pain is usually in the upper middle part of the abdomen, above the
navel and below the breastbone (epigastric pain).
• The ulcer pain can feel like burning and it may go through to the back.
• Pain often comes several hours after a meal when the stomach is empty.
• The pain is often worse at night and early morning.
• It can last anywhere from a few minutes to several hours.
• The ulcer pain may be relieved by food, antacids, or vomiting.
These are very noticeable signs and common in most patients.
 Less common symptoms include :
• dull pain in the stomach
• weight loss
• nausea or vomiting
• bloating
• burping or acid reflux
• heartburn (which is a burning sensation in the chest)
• dark, tarry stools
The severity of the symptoms depends on the severity of the ulcer. The
symptoms of peptic ulcers may vary with the location of the ulcer . It can
range from mild to severe and sometimes doesn’t have any symptoms in
the early phases unless complications have arisen.
 When should I see a doctor if I think I have a peptic ulcer ?
• If you have burning pain in your upper stomach that is relieved by
eating or taking antacids, or have symptoms of vomiting,
heartburn,etc... you should see your doctor to talk about your
symptoms. Even if they are mild, you also may have a peptic ulcer.
• If you vomit blood or have other signs of gastrointestinal bleeding, go
to an emergency department right away. Peptic ulcers can cause
massive bleeding, which requires blood transfusion or surgery.
• Vomiting and severe abdominal pain also can be a sign of an
obstruction or may be perforation of an ulcer, another complication of
peptic ulcers.

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IV. DIAGNOSIS:
 Tests for H. pylori.
Your doctor may recommend tests to determine whether you have the
bacterium H. pylori. Which type of test you undergo depends on your
situation. H. pylori may be detected in a blood test, in a stool test or by a
breath test.
 Using a scope to examine your upper digestive system (endoscopy).
During endoscopy, your doctor passes a flexible tube equipped with a lens
(endoscope) down your throat and into your esophagus, stomach and small
intestine. Using the endoscope, your doctor looks for signs of
inflammation.
If a suspicious area is found, your doctor may remove small tissue samples
(biopsy) for laboratory examination. A biopsy can also identify the
presence of H. pylori in your stomach lining.
 X-ray of your upper digestive system.
Sometimes called a barium swallow or upper gastrointestinal series, this
series of X-rays creates images of your esophagus, stomach and small
intestine to look for abnormalities. To make the ulcer more visible, you
may swallow a white, metallic liquid (containing barium) that coats your
digestive tract.

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V. COMPLICATION
1/ Pyloric stenosis:
- Pylorus is the part located at the end of the stomach where it connects of
the duodenum
- It is the part that keeps food in the stomach until food is ready to be moved
to the small intestine and continues to digest.
So what is pyloric stenosis?
- Pyloric stenosis is a condition that hinders the circulation of food and
gastric juice to the duodenum
- It means: Foods that have been agglomerated into the stomach cannot go
down to the small intestines
 Consequence: Stomach enlargement, gastric juice and food circulate very
slowly
 Expression: flatulence, bloating, epigastric pain, patients are thin, pallor,
fatigue and vomiting food from previous meals
- It may not be dangerous if detected and treated promptly but
if the disease gets worse it will be very dangerous, causing pain for patients
2/ Perforation of the stomach:
- Perforation of the stomach is a condition where one or more holes appear
on the stomach
- It is also a severe and serious complication of peptic ulcer disease. Patients
often appear severe abdominal pain, rock-hard stomach, vomiting,
sweating, cold hands and feet.
- It can occur at any age, most commonly working age. Especially, It is more
common in men than women, due to high alcohol. If this complication isn’t
diagnosed early and timely treatment, it will be life-threatening to patient.
3/Gastrointestinal bleeding:
- Gastrointestinal bleeding is all forms of bleeding in the gastrointestinal
tract, from the mouth to the rectum.
- Patients often have manifestations such as vomiting blood, epigastric pain,
tarry stools
- Gastrointestinal bleeding is a very dangerous complication that can be
deadly. If the bleeding is mild, the patients only feel abdominal pain,

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 fatigue, blood pressure does not change much. However, the bleeding is
severe, it will cause acute blood loss.
4/ Stomach cancer:
- Stomach cancer is the cells of the stomach that grow out of control,
forming tumors in the stomach that can spread to the surrounding organs
and further organs.
- Stomach cancer is one of the most common cancers in the world, with the
third highest rate in men and the fourth in women.
- The disease is usually silent in the early stages, so patients are often
detected at a later stages.
- The patients with stomach cancer usually have some symptoms as:
persistent pain in the epigastrium (above the navel). The first time may be
reduced after eating, then severe abdominal pain, burp constantly, nausea
accompanied by anorexia, heartburn, dysphagia due to tumors
- Stomach cancer may be treated, if it is diagnosed early. Surgery to remove
the damaged mucosa, chemotherapy and radiation therapy.

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VI. TREATMENT:
A. NON- SURGICAL TREATMENT:
 Symptomatic treatment:
- Symptomatic treatment is available drug treatments, which includes 2 group of
drugs:
 Medications to inhibit Hydrochloric acid
 Medications to protect and strengthen the mucous lining of the stomach
- They help to reduce gastric acid and coat the ulcers
1. Medications to inhibit Hydrochloric acid:
a. Antacids:
- The main ingredients are Al, Mg salts in the form of phosphate, carbonate,
trisilicate. Antacids neutralize existing stomach acid and can provide rapid pain
relief. The disadvantage is that you need to take a relatively large dose for them
to be effective, and they can cause unwanted side effects like diarrhea.(because
the ingredient has Mg) or constipation (because the ingredient has Al).
b. 𝑯𝟐 - receptor antagonists:
- 𝐻2 -receptor antagonists work by reducing the amount of acid your stomach
produces. Ranitidine is a type of 𝐻2 - receptor antagonists and it is the most
common type used for treating gastric ulcer. 𝐻2 - receptor antagonists have slow
chemical action because they require time to absorb into the body. The time of
action about 5-7h. They have many side-effects (renal insufficient, hepatic
disease). They occur drug tolerance so hospitals and pharmacies rarely use them.
c. Proton pump inhibitors (PPIs):
- Proton pump inhibitors — also called PPIs — reduce stomach acid by blocking
the action of the parts of cells that produce acid.
- PPIs reduces the amount of acid your stomach produces, prevents further damage
to the ulcer. They're usually prescribed for 4 to 8 weeks. The most common types
of PPIs used to treat stomach ulcers are Omeprazole and Pantoprazole. Today,
people use PPIs more than 𝐻2 - receptor antagonists because it suppresses acid
production much more effectively and it has no drug tolerance. Side-effects of
these are usually mild, but can include: headache, diarrhea.
1. Medications to protect and strengthen the mucous lining of the
stomach :
- These drugs protect the mucous lining of the stomach from acid, but they do not
affect the amount of acid in the stomach. The common types of drug include:
Sucralfate, Misoprostol
 Treatment of the causes:
1. The cause is Helicobacter pylori infection:

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- PPIs reduce stomach acid by blocking the action of the parts of cells that produce
acid and has fast chemical action
- Antibiotics: Killing the Helicobacter pylori. You’ll ussually be prescribed a
combination of 2 antibiotics to kill the bacterium. These may include amoxicillin,
clarithromycin, metronidazole.
- Dual therapy: It associates 2 antibiotics including amoxicillin, clarithromycin
and a proton pump inhibitor (PPI). This simplified schedule is preferred by many
people.
Amoxcilin 2g/day
Clarithromycin 1g/day
PPI 40mg /day

- Patients should use all 3 drugs, should not use lack of 1 in 3 drugs because
increasing the risk of drug resistance. Doctors always advise patients not to use
alcohol and smoke during treatment time
2. The cause is NSAIDs:
- The best way is to stop using them. Sometimes an alternative type of NSAID
that's less likely to cause stomach ulcers, called a COX-2 inhibitor, may be
recommended
B. SURGICAL TREATMENT:

Surgical operations often used in peptic ulcers include the following:

 Vagotomy: Cutting the vagus nerve, which transmits messages from the brain to
the stomach, can reduce acid secretion. However, this can also interfere with other
functions of the stomach. A newer operation cuts only the part of the nerve that
affects acid secretion.
 Antrectomy: This is often done in conjunction with a vagotomy. It involves
removing the lower part of the stomach (the antrum). This part of the stomach
produces a hormone that increases production of stomach acid. Adjacent parts of
the stomach may also be removed.
 Pyloroplasty: This procedure also is sometimes done with vagotomy. It enlarges
the opening between the stomach and duodenum to encourage passage of partially
digested food. Once the food has passed, acid production normally stops.

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 Tying off an artery: If bleeding is a problem, cutting off the blood supply
(artery) to the ulcer can stop the bleeding.
 The most effective procedure for peptic ulcer disease is truncal vagotomy-
antrectomy, which has a recurrence rate of less than 1%.

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VII. PREVENTION:
There are many ways to prevent this disease. Some helpful tips to prevent or allow
healing of ulcers include:
- Stop smoking. Heavy smokers are more likely to develop duodenal ulcers than
nonsmokers.
- Practice moderation. Heavy consumption of alcohol has been shown to
contribute to the development of ulcers, so keep your intake to a minimum.
- Learn how to control your stress levels. Regular exercise and mind-body
relaxation techniques (such as guide imagery and yoga or tai chi) are often helpful.
- Take non-steroidal anti-inflammatory drugs (NSAIDS including aspirin and
ibuprofen) with food, as this may decrease your risk of irritating the lining of your
stomach.
- Dietary changes can be important for treating and preventing peptic ulcer.
 It is important to avoid foods and flavorings that induce the stomach to
produce acid, such as chili power, garlic, black pepper, and caffeine.
 The diet should contain lots of foods that provide plenty of vitamin A and
fiber that dissolves easily.
So, a balanced diet filled with fruits and vegetables and lacking in intense spices and
flavors should assist with a peptic ulcer.

- Prevent H. pylori infection:

 Washing your hand often during the day with warm water and soap so you
don’t catch or spread H. pylori bacteria.
 Cook meat and other foods all the way through.
 Only drink water that you know is clean.
Maintaining a healthy lifestyle by quitting smoking cigarettes and other tobacco
use and eating a balanced diet rich in fruits, vegetables, and whole grains will
help you prevent developing a peptic ulcer.

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PREFERENCES:
1. https://www.emedicinehealth.com/peptic_ulcers/article_em.htm#what_are_t
he_symptoms_of_a_peptic_ulcer_does_it_cause_pain
2. https://www.healthline.com/health/stomach-ulcer#symptoms
3. https://en.wikipedia.org/wiki/Peptic_ulcer_disease
4. https://www.nhs.uk/conditions/stomach-ulcer/causes/
5. https://www.mayoclinic.org/diseases-conditions/peptic-ulcer/symptoms-
causes/syc-20354223#targetText=Peptic%20ulcers%20occur%20wh
6. https://www.emedicinehealth.com/peptic_ulcers/article_em.htm#will_surger
y_cure_a_peptic_ulcer
7. https://pddt.medinet.org.vn/Home/Detail/109
8. https://www.medicalnewstoday.com/articles/311636.php?fbclid=IwAR2qml
Qcdo5qJHONu3a0ONZ1X2N95vvbiUSqrR7KtMYYmxOND5XvIecpLn8

Members of group 3:
Nguyễn Thị Mỹ Xinh 1853010264
Cao Thị Diểm Hương 1853010818
Nguyễn Hồ Thanh Thảo 1853010850
Phạm Thanh Ngân 1853010824
Nguyễn Thị Xuân Trúc 1853010828
Trần Thị Thanh Thanh 1853010257
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