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Physiology Laboratory
Small Group Discussion
Output
March 9, 2016
EPIDEMIOLOGY
In the United States, PUD affects approximately 4.5 million people annually.
Approximately 10% of the US population has evidence of a duodenal ulcer at some
time. Of those infected with H pylori, the lifetime prevalence is approximately 20%. Only
about 10% of young persons have H pylori infection; the proportion of people with the
infection increases steadily with age.
Overall, the incidence of duodenal ulcers has been decreasing over the past 3-4
decades. Although the rate of simple gastric ulcer is in decline, the incidence of
complicated gastric ulcer and hospitalization has remained stable, partly due to the
concomitant use of aspirin in an aging population. The hospitalization rate for PUD is
approximately 30 patients per 100,000 cases.
An ulcer may or may not have symptoms. When symptoms occur, they may include:
A gnawing or burning pain in the middle or upper stomach between meals or at
night
Bloating
Heartburn
Nausea or vomiting
In severe cases, symptoms can include:
Dark or black stool (due to bleeding)
Vomiting blood (that can look like "coffee-grounds")
Weight loss
Severe pain in the mid to upper abdomen
CAUSES
Different factors can cause the lining of the stomach, the esophagus, and the small
intestine to break down. These include:
Helicobacter pylori (H. pylori): a bacteria that can cause a stomach infection and
inflammation
frequent use of aspirin, ibuprofen, and other anti-inflammatory drugs (risk associated
with this behavior increases in women and people over the age of 60)
smoking
drinking too much alcohol
radiation therapy
stomach cancer
PATHOPHYSIOLOGY
Peptic ulcers result from an imbalance between factors that can damage the
gastroduodenal mucosal lining and defense mechanisms that normally limit the injury.
Aggressive factors include gastric juice (including hydrochloric acid, pepsin, and bile
salts refluxed from the duodenum), H pylori, and NSAIDs.
In general, duodenal ulcers are the result of hypersecretion of gastric acid related
to H pylori infection (the majority of cases), whereas secretion is normal or low in
patients with gastric ulcers.
DIAGNOSIS:
Tests for H. pylori- Your doctor may recommend tests to determine whether the
bacterium H. pylori is present in your body. Tests can test for H. pylori using:
> Blood
> Breath
> Stool
Treatment for peptic ulcers depends on the cause. Treatments can include:
Antibiotic medications to kill H. pylori. If H. pylori is found in your digestive tract, your
doctor may recommend a combination of antibiotics to kill the bacterium.
Proton pump inhibitors reduce stomach acid by blocking the action of the parts of
cells that produce acid. These drugs include the prescription and over-the-counter
medications omeprazole (Prilosec), lansoprazole (Prevacid), rabeprazole (Aciphex),
esomeprazole (Nexium) and pantoprazole (Protonix).
Acid blockers — also called histamine (H-2) blockers — reduce the amount of
stomach acid released into your digestive tract, which relieves ulcer pain and
encourages healing.
Antacids that neutralize stomach acid. Antacids neutralize existing stomach acid and
can provide rapid pain relief. Side effects can include constipation or diarrhea,
depending on the main ingredients.
In some cases, your doctor may prescribe medications called cytoprotective agents
that help protect the tissues that line your stomach and small intestine. Options
include the prescription medications sucralfate (Carafate) and misoprostol (Cytotec).
Another nonprescription cytoprotective agent is bismuth subsalicylate (Pepto-
Bismol).
PROGNOSIS
The mortality rate for PUD, which has decreased modestly in the last few
decades, is approximately 1 death per 100,000 cases. If one considers all patients with
duodenal ulcers, the mortality rate due to ulcer hemorrhage is approximately 5%. Over
the last 20 years, the mortality rate in the setting of ulcer hemorrhage has not changed
appreciably despite the advent of histamine-2 receptor antagonists (H2RAs) and proton
pump inhibitors (PPIs). However, evidence from meta-analyses and other studies has
shown a decreased mortality rate from bleeding peptic ulcers when intravenous PPIs
are used after successful endoscopic therapy.[19, 20, 21, 22]
Emergency operations for peptic ulcer perforation carry a mortality risk of 6-30%.
Factors associated with higher mortality in this setting include the following:
Location of ulcer (mortality associated with perforated gastric ulcer is twice that
associated with perforated
References:
1. Guyton, AC; Hall, JE: Textbook of Medical Physiology, 11th edition. Elsevier Inc.
2006.
2. Koeppen, BM; Stanton, BA: Berne and Levy Physiology, 6 th edition. Elsevier Inc.
2010.
3. en.wikipedia.org
4. http://www.webmd.com/digestive-disorders/digestive-diseases-peptic-ulcer-disease