Patient Handout Information
PEPTIC ULCER DISEASE (PUD)
PEPTIC ULCER DISEASE
About Your Diagnosis
Peptic ulcers are erosions in the lining of the esophagus, stomach, or duodenum.
Ulcers in the stomach are called gastric ulcers, and duodenal ulcers if in
the duodenum. The cause of peptic ulcer disease (PUD) is not fully known.
It is clear that Helicobacter pylori (H. pylori) does play a role in PUD.
is a bacteria found in the stomach and duodenum. Drugs such as aspirin and
non-steroidal anti-inflammatory drugs play a role in some cases of PUD, particularly
with gastric ulcers.
Peptic ulcer disease
is common; there is a 10% lifetime prevalence in men and 5% in women. Duodenal
ulcers are four times more common than gastric ulcers. Peptic ulcer disease
is detected by an upper gastrointestinal (GI) x-ray or endoscopy (a flexible
lighted tube used to view the stomach and duodenum). Occasionally biopsy specimens
are obtained during the endoscopy to make sure a more serious disease is not
present. Testing is available to determine whether H. pylori is present in
the stomach and duodenum.
With treatment, ulcers
do heal within a few weeks. However ulcers do reoccur. Before treatments for
H. pylori, reoccurrence was common. Many individuals required long-term maintenance
treatment. Since the development of effective treatments for H. pylori, the
reoccurrence rate is less than 10% in the first year.
Living With Your
The symptoms of a peptic ulcer do not vary depending on location. The most
common symptom is pain, occurring in the epigastric (upper abdominal) area.
It is described as a burning, gnawing, or boring pain. It generally occurs
13 hours after meals. It may awaken one from sleep. The pain is relieved by
food or antacids. The pain appears in clusters. It may be present for a few
weeks, then resolve for weeks to months only to return. Other symptoms of
PUD include abdominal bloating, heartburn, nausea, and vomiting. Up to 25%
of individuals with PUD will initially be seen with a complication of the
disease. Internal bleeding is a common complication. Some individuals with
PUD will have black, tarry stools indicating a bleeding ulcer. Others will
have vomiting with blood or "coffee ground" material in it. The bleeding may
be severe enough to cause shock. Others will initially be seen with a perforation.
A perforation is a hole in the stomach or duodenum. The pain of a perforation
happens suddenly and is severe. The pain starts in the epigastric area and
moves to the right shoulder.
The goal of treatment is to heal the ulcer, help the symptoms, stop relapses,
and avoid complications. There are two treatment options: medication and surgery.
Medications are used to decrease the acid production in the stomach and treat
the H. pylori (when present). Antacids have been available for many years
to treat ulcers. However, they can be inconvenient because of the frequency
in which they have to be taken. To decrease acid production, a histamine-2
(H2) blocker is frequently given. Another drug, sucralfate, coats the ulcer
and protects the lining of the stomach from the acid. Proton pump inhibitors
such as omeprazole can be used to suppress the acid secretion. Multiple drug
combinations are used to treat the H. pylori infection. Antibiotics, proton
pump inhibitors, and bismuth are used in various combinations. After the treatment
is completed, many individuals are started on a lower dose of the medicine
to prevent reoccurrence.
Surgery is an option
when medications fail or there are serious complications. There are different
options that the surgeon may choose depending on the type of ulcer and the
complications that may be present. Because medications have improved in recent
years, the frequency of surgery has declined.
1) Maintain proper eating habits.
2) Take medications as prescribed.
3) Antacids may help relieve the symptoms.
4) Try to reduce the stress in your life. It can play a role in ulcer formation.
1) Avoid smoking.
2) Avoid excess alcohol consumption.
3) Avoid aspirin and nonsteroidal anti-inflammatory drugs.
4) Avoid caffeine and any food that makes the symptoms worse.
When to Call Your
1) If you have symptoms of an ulcer.
2) If you vomit blood or "coffee ground" material.
3) If there is blood in the stool or stools are dark and tarry.
4) If pain does not improve with treatment
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1998, Mosby, Inc.