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Peptic Ulcers(PU)

Peptic Ulcers(PU): Causes, Symptoms, Diagnosis, and Management

Peptic Ulcers(PU) are open sores in the stomach lining (gastric ulcers) or duodenum (duodenal ulcers), caused by impaired mucosal defenses against digestive acids. Below is a synthesis of their key aspects, supported by clinical guidelines and research.

Causes

1. Primary Causes:
   • Helicobacter pylori (H. pylori) infection:
     • Mechanism: H. pylori secretes urease (neutralizes stomach acid) and virulence factors (e.g., CagA, VacA) that damage the mucosa35.
     • Prevalence: Linked to ~60% of gastric ulcers and ~90% of duodenal ulcers14.
   • Nonsteroidal anti-inflammatory drugs (NSAIDs):
     • Mechanism: Disrupt the stomach’s protective mucus layer, increasing acid exposure15.
     • Risk: Long-term NSAID use accounts for ~30% of PUs5.
2. Secondary Causes:
   • Stress: Critical illness or surgery reduces blood flow to the stomach, impairing healing5.
   • Genetic predisposition: Rare familial cases linked to mutations in CDH1 or CTNNB13.

Symptoms

Common Symptoms	Severe/Complications
Burning or gnawing upper abdominal pain	Bleeding: Vomiting blood (red/black) or black/tarry stools14.
Pain worsens between meals (duodenal) or after eating (gastric)34	Perforation: Sudden, severe pain radiating to the back35.
Nausea, bloating, or early satiety	Obstruction: Vomiting, weight loss, or abdominal distension5.
Heartburn or belching	Anemia: Fatigue, dizziness (chronic blood loss)14.

Asymptomatic cases: ~33% of older adults3.

Diagnosis

1. Endoscopy:
   • Gold standard: Direct visualization of ulcers and biopsies to rule out cancer or H. pylori15.
2. Stool/urea breath test: Detects H. pylori infection14.
3. Blood tests:
   • Complete blood count (CBC): Identifies anemia from chronic bleeding4.
   • Anti-H. pylori antibodies: Less specific but useful for screening3.

Treatment

1. First-Line Therapy:
   • Proton pump inhibitors (PPIs): Reduce acid production (e.g., omeprazole, lansoprazole)58.
   • H. pylori eradication: Triple therapy (PPI + clarithromycin + amoxicillin/metronidazole) for 7–14 days15.
2. NSAID-Induced Ulcers:
   • Stop NSAIDs: Switch to acetaminophen if possible5.
   • Misoprostol: Protects the stomach lining if NSAIDs are unavoidable5.
3. Complications:
   • Bleeding: Endoscopic cauterization or IV PPIs45.
   • Perforation: Surgical repair35.

Prevention

• Avoid NSAIDs: Use alternatives (e.g., acetaminophen) for pain relief5.
• H. pylori screening: For high-risk populations (e.g., family history of stomach cancer)14.
• Hygiene: Reduce H. pylori transmission via clean food/water3.

Prognosis

• With treatment: Most ulcers heal within 4–8 weeks; recurrence is common if H. pylori persists15.
• Untreated: Risk of bleeding, perforation, or gastric cancer (especially H. pylori-associated)35.

Conclusion
Peptic ulcers are treatable but require addressing underlying causes like H. pylori or NSAID use. Early diagnosis via endoscopy and targeted therapies improve outcomes and reduce complications.

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References

1. MedicalNewsToday: Peptic Ulcers
2. UCI Health: Peptic Ulcers
3. Wikipedia: Peptic Ulcer Disease
4. Mayo Clinic: Peptic Ulcer
5. Cleveland Clinic: Peptic Ulcer Disease
6. Penn Medicine: Peptic Ulcer Disease
7. Johns Hopkins: Peptic Ulcer Disease
8. Healthline: Peptic Ulcer