Peptic ulcers
A peptic ulcer forms when there is a break in the lining of the stomach or duodenum. The break allows the digestive juices to come into contact with the deeper layers of the organ wall, where they may then cause further erosion.
Both stomach and duodenal ulcers may be referred to as peptic ulcers.
Causes of peptic ulceration
In healthy individuals, the lining of the stomach and small intestine are protected against the digestive juices, but if the protective mechanisms become faulty, inflammation and ulceration may follow.
Duodenal ulcers
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Gastric ulcers
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| Gastric acid secretion increased |
Change in composition of gastric mucosa
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| Bicarbonate secretion from the pancreas reduced |
Reduced circulation within gastric mucosa
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| Emptying of stomach accelerated |
Helicobacter pylori colonization
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| Helicobacter pylori colonization |
Gastric acid secretion increased | |
Other risk factors include the use of certain drugs (particularly non-steroidal anti-inflammatory drugs [NSAIDs], which are widely used for the treatment of long-term conditions such as arthritis), as well as tobacco, alcohol, and caffeine.
The role of Helicobacter pylori
Infection with the bacterium Helicobacter pylori is present in 85–90% of patients with duodenal ulcers and 70–90% of patients with gastric ulcers. It produces toxins that damage the protective mucous membrane of the stomach and duodenum, making it more prone to damage from the gastric acid.
H. pylori infection by itself does not necessarily cause peptic ulcers, but if it is combined with other risk factors then the chances of ulceration are greatly increased.
Treatment of peptic ulcer
Treatment of peptic ulcers is based on suppressing the production of gastric acid and eradicating infection with H. pylori.
‘Triple therapy’ is offered to patients with established H. pylori infection; this consists of a PPI to suppress acid production, and two antibiotics to treat the infection. After eradication, 90% of patients remain symptom-free for long periods.
Acid suppression alone, without H. pylori eradication, is less effective at producing long-term healing of ulcers.
Zollinger-Ellison syndrome
Zollinger-Ellison syndrome is a rare condition caused by the abnormal production of the hormone gastrin, leading to excessive production of acid in the stomach. Patients suffer from severe, multiple peptic ulceration, which is more painful and less responsive to treatment than typical peptic ulcers. Effective treatment is important to relieve symptoms and because there is a high risk of complications such as perforation and internal bleeding.
PPIs are the treatment of choice for patients with Zollinger-Ellison syndrome. High doses may be needed and treatment may be prolonged.
Long-term prevention
Long-term treatment with a low dose of a PPI is available for patients who require treatment with NSAIDs and are at risk of peptic ulceration. This enables them to continue to take NSAIDs with a much lower risk of GI complications.