Peptic Ulcer Disease

General Description:

Peptic ulcer disease is a chronic, recurrent condition that manifests in the stomach and duodenum, characterized by defects in the mucous membrane (ulcers). These disorders occur as a result of disturbances in the nervous and hormonal mechanisms in the human body, which regulate the secretory and healing processes in the stomach and duodenum. Peptic ulcer disease is characterized by acute periods (in spring and fall) and periods of remission. Scar tissue forms as a result of ulcer healing.

The prevalence of peptic ulcer disease in all countries is about 4-6% of the adult population. When patients are fully examined, this rate rises to 20-25%.

The peak incidence occurs in the age group of 30-45 years. Peptic ulcer disease in the stomach and duodenum is more common, with an average of 3-4 times among men aged 35-50 years.

Causes of Peptic Ulcer Disease:

  • Presence of Helicobacter pylori bacteria in the stomach and duodenum, which is considered the primary factor in the development of ulcers. There is no evidence of the effect of other bacteria.
  • Disturbance in dietary patterns.
  • Excessive alcohol consumption and tobacco smoking.
  • Prolonged use of medications that affect the mucous membrane of the stomach, such as nonsteroidal anti-inflammatory drugs and corticosteroids (prednisolone).
  • Emotional stress and psychological pressure.
  • Genetic inheritance.
  • Disorders in metabolic processes.
  • Vitamin deficiencies.

Symptoms of Peptic Ulcer Disease in the Stomach and Duodenum:

  • Continuous or intermittent pain, of low intensity, in the epigastric area, often occurring during fasting or immediately after eating.
  • Continuous heartburn, especially at night and in the morning, with acid reflux.
  • Nausea.
  • Belching, with an acidic or bitter taste.
  • Heaviness in the epigastric area after eating, and a feeling of rapid fullness in the stomach.
  • Decreased appetite.
  • Bleeding from ulcers, which may manifest as “coffee ground” vomiting and dark stools (melena).
  • When an ulcer perforates, there is a sharp, stabbing pain in the epigastric area, accompanied by nausea, vomiting, and abdominal muscle tension.

Diagnosis of Peptic Ulcer Disease includes:

  • Complete blood count and urinalysis.
  • Stool analysis for coprogram.
  • Stool analysis for occult blood.
  • Biological blood tests (liver tests, cholesterol, alkaline phosphatase).
  • Electrocardiogram (ECG).
  • X-rays of the chest in two directions and abdominal X-rays (to exclude ulcer perforation).
  • Barium swallow X-ray for the esophagus and stomach.
  • Ultrasonography of the hepatobiliary system.
  • Monitoring of pH (acid) levels in the esophagus and stomach for 24 hours.
  • Upper gastrointestinal endoscopy (EGD).
  • Non-gas tests to detect Helicobacter pylori bacteria (breath test).

Treatment of Peptic Ulcer Disease:

Adopting a Healthy Lifestyle and Proper Nutrition:

  • Avoiding alcohol and alcoholic carbonated beverages.
  • Weight reduction.
  • Smoking cessation.
  • Avoiding large meals and late-night eating.

Pharmacological Treatment:

  • If symptoms do not improve with non-pharmacological measures, medications are used.
  • Proton pump inhibitors (to reduce gastric acid secretion).
  • Prokinetics (to enhance food movement from the esophagus to the stomach).
  • Antacids.
  • Bismuthate tripotassium dicitrate.

Treatment of Helicobacter pylori Infection:
If infection with this bacterium is detected, a treatment regimen including antibiotics is used.

Surgical Treatment:

  • Regarding surgery, the decision is made based on the patient’s health condition, with surgery being the optimal choice in facing complications such as bleeding, perforation, penetration, or in cases of recurrent exacerbation or significant deformities in the stomach and duodenum due to changes in scars.