Diagnosis And Treatment Of Peptic Ulcers (Duodenal, Gastric)

Diagnosis Of Peptic Ulcer

Peptic ulcer is suspected when a person complains of the typical kind of pain associated with the condition. Usually, treatment is initiated without further tests and if the symptoms subside with the treatment, it is assumed that the peptic ulcer has been cured.

If the symptoms still persist after several weeks of treatment, further tests are done to determine the exact cause. If weight loss also occurs with the symptoms of peptic ulcer in people over 45 years, tests are conducted to rule out stomach cancer which may produce the same symptoms. When ulcers occur in unusual places, or in unusually high numbers, or if they seem resistant to treatment, overproduction of acids is suspected to be the cause. Further investigations are undertaken to detect the cause of the overproduction.

Endoscopic examination done with the help of a camera attached flexible tube may give a good picture of the condition inside the stomach and duodenum. X-rays taken after the ingestion of a radio opaque dye such as barium provides an outline of the interior wall of the stomach. But endoscopy is preferred over barium contrast x-rays as it is more reliable and also safe for people who have had a gastrectomy surgery. It is also possible to do a biopsy with the endoscope so that the tissue can be checked for Helicobacter pylori bacteria as well as cancer. Bleeding from the ulcer can be stopped with the help of the endoscope.

However, barium contrast x-rays can often give a better idea about the size and severity of an ulcer which may be missed by the endoscope or those ulcers which are hidden by a tissue fold. Ulcers deep down in the duodenum are also detected by barium x-ray.

Treatment Of Peptic Ulcer

Antibiotics often become an integral part of the treatment because of the high incidence of ulcer due to the infection with Helicobacter (H) pylori bacteria. Bismuth subsalicylate is also used along with antibiotics for treatment of h pylori. Drugs that help to neutralize the acids produced or those which reduce the production of acids, when taken for a month or two, often heal the condition. Bland diets which reduce the acid production are often recommended, but there is no proof of their effectiveness in healing the ulcers or preventing their recurrence. However, people are encouraged to avoid those items of food which trigger bloating and pain, as well as NSAIDs and other substances such as nicotine and alcohol which may irritate the stomach.

Antacids: Antacids do not play a direct role in healing the ulcers, but they relieve symptoms and increase the pH level of the stomach, indirectly helping with the healing process by providing an environment that is conducive to the healing of the ulcer. They also help in avoiding a recurrence. Antacids are available as over the counter drugs and both tablets and liquid suspensions can be purchased without a doctors’ prescription. But, if the person is taking other drugs, the possibility of drug to drug interactions should be discussed with a doctor or qualified pharmacist.

Baking soda or Sodium bicarbonate as well as calcium carbonate, are strong, quick-acting antacids which can be taken occasionally, but regular use may cause headache and nausea as a result of those substances making the blood alkaline. Use of antacids should be limited to a few days at a time, and it should be completely avoided by people who have hypertension or heart failure, because they are high in salt.

Aluminum hydroxide is a milder antacid which can be safely used by those who are on low-sodium diet, but they cause reduction of calcium and phosphate levels in the blood leading to loss of appetite and weakness. People who have kidney disease and those on dialysis may suffer severe side effects from aluminum hydroxide. It may precipitate constipation too.

Magnesium hydroxide does not cause constipation but if more than 4 doses taken in a day, it may result in diarrhea. Since it is more effective compared to aluminum hydroxide, it is commonly used for fast and effective neutralization of acids. The downside is that magnesium gets absorbed by the blood, which may be harmful for people who have kidney damage. Sometimes a combination of aluminum hydroxide and magnesium hydroxide is used as an antacid. As a general rule, people who have disorders such as high blood pressure, heart disease or kidney disorder should consult a doctor, to help them choose the antacid which may be least harmful to them.

Acid-reducing Drugs: Some drugs help in relieving the symptoms of peptic ulcer and promote the healing of the condition by inhibiting the production of acids. Proton pump inhibitors belong to that group, and they also happen to be the most effective in accelerating the healing process. Zollinger-Ellison syndrome, which causes overproduction of stomach acids, also can be effectively treated with histamine-2 blockers.

Histamine-2 (H2) blockers reduce the amount of acids produced by the stomach. Most of the H2 blockers such as, famotidine, andranitidin, nizatidine, are found to be without any serious side effects except for cimetidine which is known to cause confusion in older people, in addition to interfering with the elimination of asthma drug theophylline, anticoagulant warfarin and anti seizure drug phenytoin.

A protective layer formed at the base of the ulcer by Sucralfate is found to accelerate the healing of the ulcers. This is especially beneficial to those who cannot take an antacid due to other reasons. Since this drug is not absorbed by the blood, it has fewer side effects, though it causes constipation. Also, sucralfate is known to make other drugs less effective.

Misoprostol is another effective drug which reduces the acid production of the stomach, while it also makes the lining of the stomach resistant to the action of the acid. It also protects against development of ulcers in the stomach and in the duodenum due to the damaging effect of NSAIDs. People who take corticosteroids and aspirin find misoprostol beneficial, especially if they are prone to developing ulcers as a result taking those drugs. It is of benefit to the older people too.

However, misoprostol is not suitable for pregnant women, as it is known to cause spontaneous abortions. 30% of people who take this drug have side effects such as diarrhea. People taking aspirin, NSAIDs, or corticosteroids can substitute misoprostol with proton pump inhibitors, if the side effects of misoprostol are unpleasant.

Surgery: With the availability of effective drugs to cure peptic ulcers, surgery is no longer considered a treatment of choice. It is possible to stop the bleeding of an ulcer using endoscope. But surgery may become necessary, if peptic ulcer has perforated the wall or if edema due to ulcers have caused blockage to the smooth passage of food. When cancer is detected or when there is severe bleeding from several ulcers, surgical procedures are resorted to. But as in any other surgery, possible risks due to surgery should be carefully weighed against the benefits.

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Yasser Elnahas

MD, PHD, Professor Of CardioVascular Surgery
Dr. Yasser Elnahas, Is an associate Professor of Cardiovascular Surgery. Dr. Elnahas was trained as a fellow At Texas Heart Institute And Mayo Clinic Foundation.Dr. Elnahas is dedicated to educating the general public about different disease conditions and simplifying the medical knowledge in an easy to understand terminology.

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