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Home > Peptic ulcer

1 Signs and symptoms

Symptoms of a peptic ulcer can be:

• Abdominal pain;
• Hematemesis (vomiting blood);
• Melena (tarry feces due to oxidised iron from hemoglobin);
• Weight loss;
• Rarely, an ulcer can lead to a gastric or duodenal perforation. This is extremely painful and requires immediate surgery.

A history of heartburn, gastroesophageal reflux disease (GERD) and use of certain forms of medication can raise the suspicion for peptic ulcer. Medicines associated with peptic ulcer are NSAID (non-steroid anti-inflammatory drugs) that inhibit cyclooxygenase 1, and most glucocorticoids (e.g. dexamethasoneChemical structure of dexamethasone Dexamethasone is a synthetic member of the glucocorticoid class of hormones. It is about 40 times stronger than hydrocortisone. Its chemical name is 9-Fluoro-11ss,17,21-trihydroxy-16a-methylpregna-1,4-diene-3,20-dione'').

In patients over 45 with more than 2 weeks of the above symptoms the odds for peptic ulceration are high enough to warrant rapid investigation by EGD (see below).

In earlier times it was thought that the timing of the symptoms in relation to the meal could differentiate between gastric and duodenal ulcers: a gastric ulcer would give pain during the meal, as gastric acidGastric acid is the main secretion of the stomach, characterised by HO, hydrochloric acid and several enzymes (mainly pepsinogen). Physiology Gastic acid is produced by the parietal cell (wall cell) of the gastric mucosa. The pH of gastric acid is 2-3, th was secreted, while duodenal ulcers would only hurt after the meal—when acidic chylus was passed down to the duodenum. This theory has not been proved in practice.

2 Diagnosis

In patients in whom peptic ulcer is suspected, esophagogastroduodenoscopyIn medicine ( gastroenterology), esophagogastroduodenoscopy (EGD) or upper endoscopy is a diagnostic endoscopic procedure that visualises the upper part of the gastrointestinal tract. It is considered a minimally invasive procedure since it does not requi (EGD, a form of endoscopyEndoscopy is a minimally invasive diagnostic medical procedure used to evaluate the interior surfaces of an organ by inserting a small scope in the body, usually through a natural body opening. Through the scope, one is able to see lesions, take small bio) is indicated. By direct visual identification, the location and severity of an ulcer can be described. Moreover, if no ulcer is present, EGD can often provide an alternative diagnosis.

The diagnosis of Helicobacter pylori can be by:

• Biopsy during EGD;
• Breath testing (does not require EGD);
• Direct culture from an EGD biopsy specimen;
• Direct detection of ureaseUrease EC 3. 5) is an enzyme that catalyzes the hydrolysis of urea into carbon dioxide and ammonia. The reaction occurs as follows: (NH)CO + 3HO → CO + 2NHOH In 1926 James Sumner shows that urease is a protein. Urease is found in bacteria, yeast and activity in a biopsy specimen;
• Measurement of antibodyantigen An antibody is a protein complex used by the immune system to identify and neutralize foreign objects like bacteria and viruses. Each antibody recognizes a specific antigen unique to its target. Antibody structure Antibodies are glycoproteins foun levels in blood (does not require EGD). It is still slightly controversial whether a positive antibody without EGD is enough to warrant eradication therapy.

The possibility of other causes of ulcers, notably malignancy ( gastric cancer) needs to be kept in mind. This is especially true in ulcers of the large curvature of the stomach; most are also a consequence of chronic H. pylori infection.

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Topics: Peptic Ulcer Ulcers Gastric Egd Pylori Symptoms Helicobacter...

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Peptic ulcerPeptic ulcer is a non-malignant ulcer of the stomach (called gastric ulcer or duodenum (called duodenal ulcer . By far most instances are now known to be be due to Helicobacter pylori a spiral-shaped bacterium that lives in the acid environment of the sto