Expertise Details




• Peptic ulcer refers to an ulcer in the lower oesophagus, stomach or duodenum, in the jejunum after surgical anastomosis to stomach, and in the ileum adjacent to a Meckel's diverticulum.

• Incidence-IO% of all adult males.

• Approximately 90% of peptic ulcers are caused by Helicobacter pylori infection or nonsteroidal anti-inflammatory drug (NSAID) use.


• Heredity

   • Strong family history with gastric ulcers, but less strong family history with duodenal ulcers.

• Acid pepsin versus mucosa! resistance.

• Other risk factors include smoking and alcohol consumption.


Helicobacter pylori

• Majority of gastric and duodenal ulcers can be attributed to NSAIDs and H. pylori.

• H. pylori also plays a role in the development of gastritis, MALT (mucosal-associated lymphoid tissue) lymphoma (most common site is stomach), gastric adenocarcinoma, gastritis and dyspepsia.

• H. pylori is a gram-negative bacillus that produces mucosa! damage.

• In a developing country, nearly 80% of persons are colonised with it by the age of 20 years. Other risk factors for acquiring H. pylori infection include poor socio- economic conditions and family overcrowding.

• Transmission occurs following oral-oral or faeco-oral route.

Aetiology of Acute and Stress Ulcers

• Aspirin

• Head injury, burns, severe sepsis, surgery and trauma lead to peptic ulceration known as stress ulcers.

   • Head injury causes ulcers by gastric hypersecretion (Cushing's ulcer).

   • Burns and shock produce ulcers by reflux of duodenal contents

Clinical Features

• Peptic ulcer is a chronic condition with a natural history of spontaneous relapses and remissions lasting for decades or even life.

• The most common presentation is that of recurrent abdominal pain that has three notable characters:

   • Localisation to the epigastrium

   • Relationship to food

   • Periodicity ·

• Epigastric pain

   • Pain is referred to epigastrium and is so sharply localised that the patient will localise the site with one finger (pointing sign). It is usually burning in character.

• Hunger pain

   • Pain occurs on empty stomach (hunger pain) and is relieved by food or antacids.

• Night pain

   • Typically, the pain wakes the patient from sleep around 3 am and is relieved by food, milk or antacids.

• Pain relief

   • Pain is usually relieved by food, milk, antacids, belching or vomiting.

   • In some patients with gastric ulcer, food may precipitate the pain.

• Periodicity (episodic pain)

   • Pain occurs in episodes, lasting 1-3 weeks every time, three to four times a year. Between episodes patient is perfectly well.

   • In the initial stages, the episodes are short in duration and less frequent. As the natural history evolves the episodes become longer in duration and more frequent.

   • Patients are more symptomatic during winter and spring.

   • Relapses are more common in smokers than in non-smokers.

• Other symptoms

   • Water brash (excessive salivation), heart bums, loss of appetite and vomiting.

   • Anorexia, nausea, fullness, bloating and dyspepsia.


• Upper gastrointestinal bleed   • Perforation   • Gastric outlet obstruction   • Gastric malignancy   • Pancreatitis


• Double contrast barium meal may show the ulcer as a crater or as a deformed duodenal cap.

• Endoscopy can visualise the ulcer. Typical location is duodenal bulb and lesser curvature of stomach. A biopsy can be taken from a gastric ulcer to rule out malignancy (10% of gastric ulcers are malignant) and H. pylori infection.

• Tests for H. pylori.

General Measures

• Avoid smoking   • Avoid aspirin and NSAIDs   • Alcohol to be moderated

• No special dietary advice though patients should avoid any foods that precipitate symptoms



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