PEPTIC ULCER

Peptic ulcers are holes or breaks in the inner lining of the esophagus, stomach, or duodenum. It has been determined that peptic ulcer generally occurs in the lower part of the stomach (gastric ulcer), in the initial portion of the duodenum (duodenal ulcer), and occasionally in the lower esophagus (esophageal).

The signs and symptoms of the peptic ulcer are the following: burning, aching, or hunger discomfort in the upper abdomen or lower chest (that is relieved by milk or food); black stools; bloated feeling after meals; and nausea or vomiting. In emergency cases the person has clammy skin and fainting.

The cause of ulcers is not fully known. Normally, the linings of the esophagus, stomach, and duodenum are kept intact by a balance between the acid and stomach juices and the resistance of these linings to injury. When the balance breaks down, the result may be a peptic ulcer. Recent research has shown that many ulcers may be secondary to bacteria called Helicobacter pylori (H pylori).

Peptic ulcers are not uncommon in our society. It has been estimated that the age at diagnosis peaks between 30 and 50 for duodenal ulcers and between 60 and 70 for gastric ulcers. Frequently, ulcers recur within 1 year after healing, sometimes without symptoms.

Some people may have an inherited disposition to ulcers. Peptic ulcers are 3 times more likely to occur in families of patients with duodenal ulcer than in the general population. And relatives of people with gastric ulcers have the very same kind of ulcer.

The goals of treatment are to relieve symptoms, heal the ulcer, prevent relapse, and avoid complications.

The vast majority of persons with peptic ulcer disease responds well to medication. The key to treatment is either decreasing the amount of acid present or strengthening the protective lining of the stomach or duodenum. The mainstay of treatment is a class of drugs that decrease the amount of acid produced in the stomach. These drugs are called H12 blockers. The usual course of therapy lasts approximately 6 weeks. Many people with ulcers harbor H pylori bacteria, which can be effectively treated with antibiotics. Twelve months after treatment, most people show no ulcer recurrence, while recurrence is more common after using standard ulcer medications.

However, if the person has an ulcer that does not respond to medical treatment or the person has serious complications such as hemorrhage, obstruction, or perforation, he/she may be a candidate for surgery.