peptic%20ulcer%20disease
PEPTIC ULCER DISEASE
Peptic ulcer disease is the presence of ulceration in the stomach and proximal duodenum commonly and in the lower esophagus, distal duodenum or jejunum infrequently. It is characterized by mucosal damage secondary to pepsin and gastric acid secretion.
It is the principal cause of upper gastrointestinal hemorrhage.
Appropriate therapy depends on the cause of peptic ulcer disease.

Patient Education

Alcohol
  • A strong promoter of acid secretion
  • An independent risk factor for peptic ulcer disease (PUD)
    • Chronic alcohol drinkers develop ulceration while occasional drinker may only have gastritis
  • Recurrence rates of patients who consume alcohol were significantly higher in patients with gastric ulcer recurrence compared to duodenal ulcer recurrence with ulcers reappearing at the same or adjacent sites as the previous ulcers
Diet
  • There is limited or no evidence that changing the diet hastens ulcer healing or prevents recurrence
  • Patient should be advised to avoid specific foods that may precipitate dyspepsia
    • Milk has been shown to be a potent gastric acid secretion stimulus
Medication Use
  • Aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids can cause peptic ulceration
  • Patient should be advised to discontinue NSAID use; if not possible, alternative agents may be considered to prevent the development of peptic ulceration and mucosal injury
    • NSAID should be given with proton pump inhibitor (PPI), high-dose (2x) histamine2-receptor antagonists (H2RAs), or Misoprostol
    • Selective cyclooxygenase 2 (COX-2) inhibitor should be substituted for a traditional NSAID
      • COX-2 inhibitors cause significantly lower incidence of ulceration and ulcer complications
      • Usefulness has been decreased due to their association with myocardial infarction and thrombotic cardiovascular events
      • Current studies suggest that both coxibs and NSAIDs, with possible exception of full-dose Naproxen, increase cardiovascular (CV) risk
Smoking
  • Smoking increases the risk of ulcer recurrence and slows healing
    • Recurrence rates of patients who smoked were significantly higher in patients with gastric ulcer recurrence compared to duodenal ulcer recurrence with ulcers reappearing at the same or adjacent sites as the previous ulcers
    • Risk of PUD is correlated with the number of cigarettes smoked per day
  • Patient should be advised to stop smoking
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