Peptic Ulcer Disease
A peptic ulcer is a break in the mucosal lining of the stomach (gastric ulcer) or the first part of the small intestine — the duodenum (duodenal ulcer) — that extends deep enough to cause tissue loss. The stomach and duodenum are normally protected from their own acid by a layer of mucus, and ulcers develop when this protective balance is disrupted and the lining is exposed to erosive gastric acid and pepsin.
Causes
The two dominant causes account for the vast majority of peptic ulcers. Helicobacter pylori — a spiral-shaped bacterium that colonises the gastric mucosa — disrupts the mucosal defence and is present in approximately 70–80% of gastric ulcers and 90–95% of duodenal ulcers. Regular use of non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen inhibits the production of prostaglandins that are essential for maintaining mucosal integrity, predisposing to ulceration — particularly in older patients and those on multiple medications. Much less commonly, a tumour of the pancreas (Zollinger-Ellison syndrome) produces enormous quantities of gastrin, driving massive acid secretion and causing multiple, often atypical ulcers.
Symptoms
The classic symptom is a gnawing or burning epigastric pain — felt in the upper central abdomen — which in duodenal ulcers is typically relieved by food or antacids and may wake the patient at night. Gastric ulcer pain can be worsened by eating. Nausea, bloating, and loss of appetite are common accompanying features. Importantly, many peptic ulcers — particularly those caused by NSAIDs — are painless until a complication develops.
Complications
The most serious complications are gastrointestinal haemorrhage (presenting as vomiting blood or passing black, tarry stools — melaena), perforation (a surgical emergency causing sudden, severe abdominal pain and peritonitis), and gastric outlet obstruction from scarring around a duodenal ulcer.
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