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Ulcer Disease

What Is Ulcer Disease?

Ulcer disease known with many names such as peptic ulcer disease, gastric ulcer, stomach ulcer, etc., is a breach in the lining of any part of the gastrointestinal tract. When ulcers form in the stomach, they are known as gastric ulcers and when they form in the proximal parts of the small intestines, they are called duodenal ulcers. For both types of ulcers epigastric pain is a common symptom. Dietary changes do not necessarily prevent PUD (peptic ulcer disease).

Causes And Risk Factors

  • Hpylori infection one of the prominent causes of PUD
  • Genetic factors
  • Lifestyle
  • Physiologic stress
  • Certain drugs Frequent intake of NSAIDs disrupt the mucosal permeability barrier causing ulcer disease
  • Hypersecretory states this is relatively uncommon but has known to cause PUD
  • Previous instances of peptic ulcer disease
  • Tobacco use
  • Depression
  • Anaemia
  • Social deprivation
  • Use of oral steroids

Signs And Symptoms

  • Epigastric / abdominal pain generalized or severe and sharp abdominal pain
  • Water brash saliva rush to dilute the acid in the oesophagus typically after regurgitation (GERD)
  • Bloating abdominal fullness
  • Nausea
  • Copious vomiting
  • Weight loss
  • Lack of appetite
  • Haematemesis or vomiting blood
  • Melena the presence of oxidized iron from the haemoglobin results in tarry, foul-smelling black coloured stools called melena

Diagnosis

  • Physical examination reveals:

    • Mild epigastric tenderness, rebound tenderness, guarding and rigidity (in cases of complications)

    • Guaiac-positive stool due to occult blood loss

    • Acute or subacute gastrointestinal bleeding leading to melena

    • Complete or partial gastric outlet obstruction causing vomiting

  • Upper GI endoscopy highly preferred test to detect the presence of gastric or duodenal ulcers

  • Angiography where high incidences of GI bleeding is noticed

  • Fasting serum gastrin levels for the evaluation of Zollinger-Ellison syndrome

  • Biopsy

Treatments

The treatment for peptic ulcer disease depends on the clinical presentation of the patient. Most of the peptic ulcers can be treated with medications. Surgery is indicated when some complications arise. Perforation and bleeding are the most common life-threatening complications. Acute ulcer perforation is a surgical emergency. It causes severe inflammation of the peritoneum causing peritonitis. If treatment is delayed, it can lead to sepsis and can even cause death. The ulcer perforation is usually closed with key hole surgery.

Bleeding is less common and can many a time tackled with endoscopy. Surgery is indicated if endoscopy fails, and bleeding persists.

Another complication of ulcer disease is obstruction. Obstruction cannot usually be treated without surgery. Laparoscopic surgery is often feasible to relieve the obstruction.

Dr. Deepak Varma offers laparoscopic treatment for ulcer disease and its complications.