Peptic Ulcer Disease
What is a peptic ulcer?
A peptic ulcer is a hole in the gut lining of the stomach,
duodenum, or
esophagus. A peptic ulcer of the stomach is called a gastric
ulcer; of the
duodenum, a duodenal ulcer; and of the esophagus, an esophageal
ulcer. An
ulcer occurs when the lining of these organs is corroded by the
acidic
digestive juices which are secreted by the stomach cells.
Peptic ulcer
disease is common, affecting millions of Americans yearly. The
medical
cost of treating peptic ulcer and its complications runs in the
billions
of dollars annually. Recent medical advances have increased our
understanding of ulcer formation. Improved and expanded
treatment options
are now available.
What are the causes of peptic ulcers?
For many years, excess acid was believed to be the major cause
of ulcer
disease. Accordingly, treatment emphasis was on neutralizing and
inhibiting the secretion of stomach acid. While acid is still
considered
significant in ulcer formation, the leading cause of ulcer
disease is
currently believed to be infection of the stomach by a bacteria
called "Helicobacter pyloricus" (H. pylori). Another major cause of ulcers is
the chronic
use of anti-inflammatory medications, commonly referred to as
NSAIDs
(nonsteroidal anti-inflammatory drugs), including aspirin.
Cigarette
smoking is also an important cause of ulcer formation and ulcer
treatment
failure.
H. pylori bacteria is very common, infecting more than a
billion people
worldwide. It is estimated that half of the United States
population older
than age 60 has been infected with H. pylori. Infection usually
persists
for many years, leading to ulcer disease in 10 % to 15% of
those infected.
H. pylori is found in more than 80% of patients with gastric
and duodenal
ulcers. While the mechanism of how H. pylori causes ulcers is
not well
understood, elimination of this bacteria by antibiotics has
clearly been
shown to heal ulcers and prevent ulcer recurrence.
NSAIDs are medications for arthritis and other painful
inflammatory
conditions in the body. Aspirin, ibuprofen (Motrin), naproxen (Naprosyn),
and etodolac (Lodine) are a few of the examples of this class of
medications. Prostaglandins are substances which are important
in helping
the gut linings resist corrosive acid damage. NSAIDs cause
ulcers by
interfering with prostaglandins in the stomach.
Cigarette smoking not only causes ulcer formation, but also
increases
the risk of ulcer complications such as ulcer bleeding, stomach
obstruction and perforation. Cigarette smoking is also a
leading cause of
ulcer medication treatment failure.
Contrary to popular belief, alcohol, coffee, colas, spicy
foods, and
caffeine have no proven role in ulcer formation. Similarly,
there is no
conclusive evidence to suggest that life stresses or
personality types
contribute to ulcer disease.
Next: What are symptoms of an ulcer? »
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