Peptic%20ulcer%20disease Signs and Symptoms
Introduction
- Peptic ulcer disease (PUD) is characterized by mucosal damage secondary to pepsin and gastric acid secretion
- Dyspepsia is a nonspecific term indicating discomfort in the upper abdomen
- It is the principal cause of upper gastrointestinal (UGI) hemorrhage
- Most commonly occurs in the stomach and proximal duodenum; infrequently, in the lower esophagus, distal duodenum or jejunum
- Giant ulcer with size of >2 cm is an atypical type of PUD that is now rarely encountered
- Refractory PUD is considered in patients with ulcer that failed to heal after 8-12 weeks of therapy
Signs and Symptoms
Clinical Features
- Epigastric pain is the most common symptom of PUD but occurs only in minority of patients
- Pain of duodenal ulcer usually occurs 2-5 hours after a meal, improves with food or antacid, and sometimes awakens patient at night
- Pain of gastric ulcer is more commonly worsened by food intake and occurs shortly after meals
- May be associated with weight loss due to fear of food intake
- Other symptoms include indigestion, vomiting, loss of appetite, inability to tolerate fatty foods, heartburn
- Nausea and vomiting are commonly experienced by patients with prepyloric or pyloric channel ulcers
Alarm Symptoms
- Hematemesis, melena, or anemia may suggest bleeding
- Vomiting and early satiety may be due to obstruction
- Anorexia or weight loss may suggest cancer
- Upper abdominal pain radiating to the back that persists may be due to penetration
- Spreading upper abdominal pain that is severe may suggest perforation
Risk Factors
- In 70% of cases, 25- to 64-year old patients are affected
- Most cases are secondary to Helicobacter pylori infection and nonsteroidal anti-inflammatory drugs (NSAIDs)
- Some evidence states that H pylori infection may be food or water borne and may spread from person to person
- In patients with a bleeding ulcer, it is recommended to test for and treat H pylori
- NSAIDs inhibit the formation of prostaglandins and their protective effect on the gastric mucosa (ie stimulates mucus and bicarbonate secretion, epithelial cell proliferation, and increase of mucosal blood flow)
- Patients who are on long-term NSAIDs have an annual risk of life-threatening ulcer-related complication of 1-4%
- H pylori plus NSAID use increases the risk and intensity of NSAID-related mucosal damage
- Other causes may include use of steroids, bisphosphonates, potassium chloride or chemotherapeutic agents, presence of acid-hypersecretory states (eg Zollinger-Ellison syndrome), cancer or stress [eg multiorgan failure, ventilator support, extensive burns (Curling’s ulcer) or head injury (Cushing’s ulcer)], lifestyle factors (eg alcohol use, smoking), genetic factors
- In patients with NSAID-related GI complications, additional contributing factors include history of complicated GI event, age, concomitant use of anticoagulants, corticosteroids, other NSAIDs including low-dose Aspirin, high-dose therapy, chronic debilitating disorders