Ulcers can develop at different areas of the gastrointestinal tract, such as esophagus, stomach, small bowel, large bowel, rectum, etc. There are varieties of causes that lead to ulcer. Different ulcers have different pathophysiological significance.

A peptic ulcer, also known as peptic ulcer disease (PUD), is the most common ulcer in the GI tract, which is usually from acidic injury to the lining of the GI lumen. Peptic ulcer that occur in the esophagus is called esophageal ulcer, in the stomach are called gastric ulcer, in the duodenum is called duodenal ulcer, etc. Duodenal ulcer is the most common PUD and is generally benign. Some of the ulcers are caused by a malignant tumor, such as gastric cancer, etc.

Risk factors

Most common risk factors are:

• Helicobacter pylori
• Drugs: such as Aspirin, Plavix, NSAIDS (Advil, Motrin, Aleve, Anaprox, etc), Steroids, and others.
• Smoking
• Alcohol use
• Spicy foods or a stressful job can precipitate peptic ulcers, but are less risk factors as commonly think.

Symptoms of PUD

Patient with PUD may not have any symptoms at all, especially with broad use of proton pump inhibitors. Generally, the symptoms of PUD are:

• Abdominal pain. Duodenal ulcers are classically relieved by food, while gastric ulcers are exacerbated by it.
• Bloating and abdominal fullness.
• Heartburn and reflux.
• Nausea and Vomiting (food and/or blood).
• Decreased appetite and weight loss.
• Dark stool (melena is the medical term, due to oxidized iron from hemoglobin).

In severe cases, a blood vessel might be eroded that can cause massive blood loss and require hospitalization. Rarely, an ulcer can cause a gastric or duodenal perforation that leads to acute peritonitis, which is extremely painful and requires immediate surgery. After healing, PUD can also lead to scar formation and cause obstruction. Sometime these ulcers can become cancer and produce symptoms malignancy.

Diagnosis and Treatment

Diagnosis of PUD is generally based on clinical presentation and one or more of the following tests:

• Blood works
• Stool studies
• X-ray
• CT
• Endoscopy

Treatment is usually based on the causes, clinical findings, and tests results.

1. Medications:

-Antacids

-H2 antagonists

-Bismuth compounds

-Sucralfate

-PPIs

-Stop offending drugs if possible

-Treat H pylori infection

2. Endoscopic therapy

3. Interventional radiology therapy

4. Surgery

References:

1. PubMed Health.
2. Wikipedia.
3. Mayo clinic online health information.
4. Sleisenger and Fordtran's Gastrointestinal and Liver Disease- by Mark Feldman MD, et al.
5. The Little Black Book of Gastroenterology-by David W. Hay.
6. Principles of Clinical Gastroenterology by Tadataka Yamada, et al.

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