PUD is the abbreviation for peptic ulcer disease. The condition is characterized by formation of ulcers in the mucous membrane of the stomach and duodenum. They may be small and only 3mm in diameter and sometimes even get larger and penetrate deeper in the tissues of the affected organ causing more complex complications.
Causes and Contributors to PUD
Damage to the surface of the stomach and duodenum is caused by inadequate protection (insufficient production of protective mucus) and excess of stomach acid.
Major contributing factors for PUD are infection with Helicobacter pylori and prolonged intake of NSAIDs (nonsteroidal anti-inflammatory drugs). Apart from that PUD may be associated with smoking, heavy alcohol consumption, bile acids, intake of steroids and stress. PUD may also affect people who have suffered severe burns and those who have just been operated.
Clinical Characteristics of PUD
Patients suffering from PUD typically complain about burning epigastric pain which may or may not radiate toward the back. In people with stomach ulcers the pain intensifies with meal while, on the other hand, people suffering from duodenal ulcers feel pain relief after they eat. Additional symptoms include nausea and vomiting, loss/increase in appetite and consequent weight loss/gain. Frequent occurrence of dyspepsia, belching, bloating and stomach distension are reported as well. And finally, complications such as bleeding develop in a form of hematemesis and melena. While examining the patient and palpating his/ her abdomen doctor can confirm epigastric tenderness.
In order to confirm PUD doctors perform different tests and exams. They include endoscopy, detection of Helicobacter pylori infection etc. During endoscopy doctor takes samples of the ulcer which are then examined. This way it is possible to differentiate simple benign ulcers from cancer.
Treatment for PUD
Treatment for PUD includes several approaches. It is essential to protect the surface of the stomach or duodenum and allow the ulcer/ulcers to heal. Furthermore, prevention is one more goal of the treatment. In people who are suffering from Helicobacter pylori doctors recommend a so called triple therapy which eradicates the bacteria and allows proper healing of peptic ulcers. And finally, intake of drugs that have led to ulcer formation such as NSAIDs or steroids should be limited, if not completely restricted. Many different drugs are used in treatment of PUD including antacids, H2 blockers, proton pump inhibitor and antibiotics.
Triple Therapy for Helicobacter Pylori Infection
This is a highly efficient treatment which lasts 10-14 days. There are two treatment regimes, PPI-based triple therapy and bismuth-based triple therapy. The first option includes a proton pump inhibitor (PPI) and two antibiotics. After the treatment is over the patient may continue taking PPI for additional 2 weeks. Bismuth-based triple therapy includes bismuth and also 2 antibiotics. The treatment may additionally include H2 receptor agonist. There are several antibiotics used in the mentioned therapies and some of them are clarithromycin, amoxicillin, metronidazole and tetracycline.
Surgery is performed only in case of complications such as perforation, obstruction, bleeding or if PUD is refractory to medicamentous treatment.