Peptic Ulcer Disease

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Peptic ulcer arise from a break in the abdominal lining either in the upper part of the intestine or lower esophagus resulting in gastrointestinal sores.

Types

Depending on the location of the ulcer, peptic ulcer is divided into two types:

  1. Gastric ulcer – here the ulcer occurs in the stomach
  2. Duodenal ulcer – here the ulcer occurs in the intestine

 Symptoms

Some symptoms are based on the location of the ulcer and the patient’s age. Both types of peptic ulcer share some common symptoms.  The following symptoms are found in peptic ulcer disease:

  1. Abdominal pain – this is also known as epigastric pain. It is a meal- related symptom and it differs in time of manifestation for gastric and duodenal ulcers. During a meal, the epigastric pain in gastric ulcer becomes so pronounced due to the production of acid as food enters the stomach. In duodenal ulcer, a meal seems to alleviate the pain since the pyloric sphincter closes to concentrate the stomach contents, so the acid does not reach the duodenum. However, some hours after the meal, when the food has been digested and the stomach releases the digested food and acid into the duodenum, the pain becomes pronounced.
  2. Distended stomach and feeling of stomach fullness.
  3. Weight loss which is usually accompanied by loss of appetite
  4. Vomiting of blood which is also known as haematemesis. The blood vomited usually comes from the gastric ulcer and damaged esophagus.
  5. The patient’s feces is usually dark-green with offensive smell due to the presence of oxidized iron from metabolized haemoglobin.
  6. In rare cases, peptic ulcer results in gastric or duodenal perforation which causes acute peritonitis that requires immediate surgical intervention

Causes

Helicobacter pylori, a bacterium, has been implicated in both types of peptic ulcer causing more than 50% of both types of ulcer. Despite the presence of H. pylori antibodies in serum, the immune system is unable to fight and resolve infections due to H. pylori which colonises the anterior part of the stomach mucosa leading to chronic inflammation that often results in gastritis.

Drugs such as non-steroidal anti-inflammatory drugs (NSAIDs) are also a major factor leading to peptic ulcer. NSAIDs such as ibuprofen and aspirin function by blocking the enzyme responsible for secreting prostaglandins which help protect the gastric mucosa by stimulating the coating of the mucosa with a layer of mucus. When this happens, the gastric mucosa becomes unprotected from gastric acid and this will eventually result in ulceration.

Unusual causes of peptic ulcer are smoking of tobacco, Zollinger-Ellison syndrome, liver cirrhosis, stress arising from severe illness, Behcet disease and Crohn disease.

Diagnosis

Diagnosis of peptic ulcer is tailored to the type of symptoms which the patient presented.  Usually, doctors give empirical treatment based on the presented signs and symptoms. Laboratory tests and other diagnostic procedures are undertaken when the disease fails to resolve.

  1. Test for H. pylori antibodies in the serum or plasma. This is not confirmatory as this test does not differentiate between previous and active infection. Blood test can also show false negative result when the patient is on some medications e.g antibiotics and proton-pump inhibitors.
  2. Confirmatory tests using endoscopies or barium contrast x-rays
  3. pylori can be detected using urea breath test. It can also be isolated from direct culture of EGD biopsy specimen. The urease activity performed by H.pylori can be checked using urease test. Other tests include stool antigen test and histological procedures involving staining and examination of EGD biopsy.

Treatment

  1. Antacids or H2 antagonists are used in children who presented with ulcer-related symptoms
  2. Prescribing prostaglandin analogue together with NSAIDs to help circumvent peptic ulcers
  3. Prescribing medication that decrease acid production e.g H2 antagonists and proton-pump inhibitors.
  4. Treating H. pylori infection when it is present with a combination of two antibiotics and a proton-pump inhibitor
  5. Surgical intervention is an emergency for perforated peptic ulcer

 

 Stem cell treatment

Some researchers have found that the risk of developing stomach ulcers increase with age, owing to some factors such as reduced ability to heal injuries. Gastric stem cells isolated from young mice have been experimentally transplanted into older mice with stomach ulcer. The transplanted cells which replaced cells at the site of injury were observed and found to speed-up the healing process. These stem cells from older mice were unable to differentiate into the specialized cell type which is responsible for the healing process.

Forecast

With the researches done so far on the use of stem cell for the treatment of stomach ulcers, there is hope that with stem cell therapy, peptic ulcer disease would in the nearest future not be difficult to deal with.

This article was written for Ikechukwu Eboh(Zache Sache), a freelancer.

 

 

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