| Peptic ulcer disease is a raw area (erosion) of the lining of the intestinal tract. Cells in the lining of the intestinal tract secrete protective mucus. Glands in the lining of the stomach secrete acid and pepsin to help break down food for digestion. Without the protective mucus, the acid and pepsin quickly eat away the stomach and the first part of the small intestine connected directly to the stomach (duodenum). When damaging influences overcome this protective mucus in the stomach or duodenal lining, the tissue in the stomach becomes eroded and an ulcer forms.
Peptic ulcers are typically found in the lower half of the stomach or the first part of the duodenum. Ulcers of the lower esophagus occur when there is a reflux of acid from the stomach. Although rare, ulcers may occur in the lower part of the small intestine (jejunum or ileum) when a large amount of gastric acid is produced in the stomach (Zollinger-Ellison syndrome).
The majority (about 75%) of peptic ulcers are caused by an infection of the stomach with a bacterial species called Helicobacter pylori, and about 25% of cases are caused by irritation of the stomach lining by aspirin or nonsteroidal anti-inflammatory drugs (NSAID's) (Shrestha). Some individuals may have a genetic predisposition toward developing peptic ulcers. Although psychological stress and excessive alcohol use may aggravate an existing ulcer, there is no evidence that they can cause peptic ulcers.Risk: Stomach ulcers most commonly occur in individuals over 60 years of age and are more common in women (Stratemeier). Incidence and Prevalence: Approximately 10% of the American population have peptic ulcers. About 350,000 to 500,000 new cases of peptic ulcers are reported annually in the US (Stratemeier). |
Source: Medical Disability Advisor
| History: Individuals with peptic ulcer disease usually report a gnawing, hunger-like pain in the upper middle abdomen that fluctuates in intensity especially when the stomach is empty. Antacids and eating may relieve the pain or sometimes make it worse. Other symptoms may include heartburn, a sour taste in the mouth, nausea, blood in the stool making it a black tarry color (melena), vomiting of blood, weakness, fatigue, belching, bloating, or weight loss. No symptoms may be reported in some cases. Physical exam: Finger manipulation (palpation) of the abdomen may reveal tenderness over the stomach (epigastric) area. Tests: X-rays may be taken using barium as the contrast medium (upper gastrointestinal series). A flexible, lighted fiberoptic microscope passed down the esophagus (upper endoscopy) enables the physician to view the stomach lining and also obtain a tissue sample (biopsy) of the visualized gastric ulcer. The presence of H. pylori can be identified from such a biopsy. Multiple biopsies from the margins of the ulcer are required to rule out cancer (malignancy). A test done on a stool sample (guaiac test) shows positive when blood is present in the stool. Other tests may include a complete blood count (CBC) to rule out anemia and tests to determine if a certain hormone is causing excess stomach acid secretion (serum gastrin test, gastric secretory test). |
Source: Medical Disability Advisor
| Treatment may include drugs that inhibit or block acid secretions (proton pump inhibitors, histamine receptor antagonists) or medications (such as sucralfate) that form a protective coating on the mucosal surface of the stomach. Antacids may be used to alleviate the symptoms of peptic ulcer. All H. pylori associated ulcers are treated with a combination of antisecretory agents and antibacterial agents. The best therapy for eradication of H. pylori appears to be a triple therapy regimen consisting of a proton pump inhibitor and two antibiotic drugs. Three antibiotics plus an antisecretory agent (quadruple therapy) may be used if triple therapy is ineffective. Ulcers resistant to treatment (refractory) may require surgery. Smoking and intake of NSAIDs and aspirin should be discontinued if possible.
Surgical intervention may include removal of the portion of stomach or duodenum where the ulcer is located (ulcer excision), cutting the vagus nerves that control the production of digestive acid (vagotomy), repair of the valve between the stomach and small intestine (pyloroplasty), or surgical removal of a portion of the stomach (gastrectomy). If bleeding from the ulcer is substantial, a blood transfusion may be necessary. It should be noted that surgery for peptic ulcer is rarely indicated, and is usually only performed in cases of life-threatening hemorrhage or those that cannot be controlled medically. |
Source: Medical Disability Advisor
| In the majority of cases of peptic ulcer disease, drug therapy provides healing of the ulcer in 6 to 8 weeks. Some individuals have recurrences requiring long-term drug therapy. Although surgery is rarely indicated, it is generally very successful with minimal morbidity and mortality. |
Source: Medical Disability Advisor
| Regular physical activity on a daily basis is recommended to relieve stress that may exacerbate peptic ulcer. Aerobic exercise for 30 to 45 minutes per session is usually beneficial.
If surgery is used as a treatment, intermittent positive pressure breathing exercises may be necessary to prevent pulmonary complications. Additionally, exercises to reduce postoperative pain, speed recovery, and strengthen abdominal muscles are important.
Exercises that help increase circulation and make walking easier are especially valuable during the first 48 hours after surgery and should be performed until recovery from surgery is complete and pain is no longer noticeable while walking or breathing. |
Source: Medical Disability Advisor
| Complications may include chronic blood loss that can result in low hemoglobin in the bloodstream (iron deficiency anemia). The wall of the digestive tract may also develop a hole (perforation) that allows blood, partially digested food, and hydrochloric acid into the abdominal cavity. Leaking digestive juices can cause inflammation of the abdominal lining (peritonitis) that produces sudden, severe pain and requires emergency hospitalization. Chronic ulcers may cause extensive scarring and result in narrowing of the outlet between the stomach and the duodenum (pyloric stenosis) that can obstruct the passage of food. |
Source: Medical Disability Advisor
| There are no work restrictions for individuals with mild or moderate peptic ulcer disease. Individuals with anemia as a result of bleeding from a peptic ulcer will need light or sedentary duty for up to 3 weeks until blood counts return to normal. If treatment includes surgery, individuals may need light to sedentary work for 2 to 4 weeks until recovery is complete. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Was the diagnosis of peptic ulcer confirmed with diagnostic x-rays or endoscopy?
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Has a gastric biopsy revealed H. pylori infection in the stomach?
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If the diagnosis was uncertain were other conditions with similar symptoms ruled out (e.g., stomach cancer, biliary tract disease, irritable bowel syndrome, hiatal hernia, pancreatic tumor, pancreatitis, gastrointestinal vascular insufficiency, and bleeding esophageal varices)?
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Has there been any evidence of upper gastrointestinal bleeding?
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Was anemia detected on a complete blood count?
Regarding treatment:
- Has individual been advised to quit smoking? Would individual benefit from enrollment in a smoking cessation program?
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Has individual limited the intake of NSAIDs and aspirin?
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Has drug treatment been effective? Are appropriate drugs included in treatment regimen? Would additional or different medication be more appropriate now?
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Is H. pylori infection being treated as appropriate with antisecretory agents and antibacterial agents (triple therapy)? If triple therapy has not proven effective, is quadruple therapy being considered?
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Was surgery required? On what basis was the specific procedure chosen?
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Has individual experienced any anemia secondary to the ulcer? If so, has this been addressed in the treatment plan?
Regarding prognosis:
- Is long-term therapy warranted?
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Has individual been compliant with treatment recommendations?
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Has individual experienced any complications, such as anemia, gastric perforation, pyloric stenosis or peritonitis that could impact recovery and prognosis?
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Does individual have an underlying condition that may impact recovery such as duodenitis or gastritis?
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Is individual now a candidate for surgical intervention?
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If individual was treated by vagotomy, what were extenuating circumstances?
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Has individual given up smoking? Would individual benefit from enrollment in a smoking cessation program?
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Has individual limited the intake of NSAIDs and aspirin? Are other alternatives available?
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Source: Medical Disability Advisor
| Shrestha, Sanjeeb, and Daryl Lau. "Gastric Ulcers." eMedicine. Eds. David Greenwald, et al. 16 Jun. 2004. Medscape. 3 Jan. 2005 <http://emedicine.com/med/topic849.htm>.Stratemeier, Michael W., and Lisa Vignogna. "Peptic Ulcers." eMedicine Consumer Health. Eds. Scott H. Plantz, et al. 13 Jul. 2004. Medscape. 3 Jan. 2005 <http://www.emedicinehealth.com/articles/10619-1.asp>. |
Source: Medical Disability Advisor