Peptic Ulcer Disease
This is a condition in which the lining of either the stomach or first part of the small bowel, the duodenum, is affected and broken. If this occurs in the stomach it is referred to as a gastric ulcer, if in the duodenum it is referred to as a duodenal ulcer.
They both have similar causes, with the most common cause being Helicobacter pylori infection. Other causes include the use of non-steroidal anti-inflammatory drugs e.g. Ibuprofen, inflammatory bowel disease, steroids, smoking and alcohol.
Locating the site of the disease can be aided by the symptoms experienced by the patient. Although both conditions result in upper abdominal pain and discomfort, gastric ulcers result in pain immediately or very close after eating and this pain is worsened by eating. In comparison duodenal ulcers result in pain approximately 2-3 hours after eating and are relieved by eating. Both conditions can be a source of bleeding. In severe cases patients may vomit blood (hematemesis) which needs urgent medical attention or they may have melena (digested blood in stool resulting in a black, tarry appearance with a distinctively pungent smell).
Diagnosis is reached via a urease breath test and/or a stool sample to test for H. pylori infection. Alternatively an endoscopy (OGD) can be performed which will allow direct visualisation and biopsies to be taken.
The management of H. pylori has been revolutionised by medication and prevented the need of surgical management. Medication involved the combination of proton pump inhibitors and antibiotics which should eradicate the infection.
NSAIDs should be avoided, and if medications have the risk of causing peptic ulcer disease then these should be taken be taken in combination with either a proton pump inhibitor (which will protect the lining of the stomach) or taken with food as a precaution. These types of medication should be used for the shortest duration of time.