Peptic Ulcer Disease

Gastrointestinal System


Clinicals - History

Fact Explanation
{"ops":[{"insert":"Introduction"},{"insert":"\n"}]}
{"ops":[{"insert":"A peptic ulcer is an open sore (ulcer), in the lining of the stomach or proximal duodenum, caused by pepsin and gastric acid secretion (peptic). Occasionally, peptic ulcer disease (PUD) may also occur in the esophagus, distal duodenum or jejunum."}]}
{"ops":[{"insert":"Dyspepsia"},{"insert":"\n"}]}
{"ops":[{"insert":"Patients may present with dyspepsia of at least 1 month, characterized by gnawing or burning epigastric pain occurring post meals (within 2 to 5 hours) or on an empty stomach, and may awaken the patient at night. It is relieved by food intake, antacids, or antisecretory agents since it counterbalances acid secretion by the stomach.\nPersisting pain suggests gastric wall penetration.\nSevere, persistent and spreading upper abdominal pain suggests perforation."}]}
{"ops":[{"insert":"Epigastric fullness"},{"insert":"\n"}]}
{"ops":[{"insert":"Sensation caused by dysfunction of gastric motor function, either by delayed or by rapid gastric emptying, with consequent distension of the proximal duodenum.\nMucosal inflammation, irritation and\/or spasm may contribute to this process. When chronic ulcers occur, this leads to stenosis, scarring, and fibrosis, such as in gastric outlet obstruction and gastric cancer."}]}
{"ops":[{"insert":"Nausea and vomiting"},{"insert":"\n"}]}
{"ops":[{"insert":"Nausea and vomiting may also accompany the presentation. These complaints are particularly prominent in individuals with gastric outlet obstruction, a complication of PUD (see below), in which marked inflammation and obstruction are present."}]}
{"ops":[{"insert":"Heartburn (pyrosis)"},{"insert":"\n"}]}
{"ops":[{"insert":"Heartburn may occur in cases of intercurrent gastroesophageal reflux or other hypersecretory states (e.g. Zollinger-Ellison syndrome, gastric outlet obstruction). It results from irritation produced by contact of the acidic gastric contents with the esophageal mucosa."}]}
{"ops":[{"insert":"Loss of appetite (anorexia) and weight loss"},{"insert":"\n"}]}
{"ops":[{"insert":"Anorexia and weight loss may be caused by fear of food intake. It can also be associated with more serious disease, such as cancer."}]}
{"ops":[{"insert":"Hematemesis and\/or melena"},{"insert":"\n"}]}
{"ops":[{"insert":"May occur in case of ulcer bleeding, either acute or subacute."}]}
{"ops":[{"insert":"Asymptomatic"},{"insert":"\n"}]}
{"ops":[{"insert":"It has been found that at least 30% of older patients do not present with abdominal pain or have less intense pain than younger patients when they have an ulcer.\nAdditionally, individuals with intercurrent splanchnic hypoperfusion (e.g. critical illness, hypovolemia), may have silent stress ulcers."}]}
{"ops":[{"insert":"Past medical history - Helicobacter pylori infection"},{"insert":"\n"}]}
{"ops":[{"insert":"Being the major cause of peptic ulcer disease, it should be ascertained in every patient. It might be useful to address previous diagnosis of Helicobacter pylori infection, mainly if left untreated, or if no test of cure is documented."}]}
{"ops":[{"insert":"Past medical history - Other comorbidities"},{"insert":"\n"}]}
{"ops":[{"insert":"Other infections have been described as increasing the risk of PUD (tuberculosis, cytomegalovirus).\nComorbidities described as risk factors for PUD include past history of PUD, Crohn\u2019s disease, hepatic cirrhosis chronic renal failure, sarcoidosis, myeloproliferative disorders, critical illness and some cancers (gastric, lung and lymphomas).\nRarely, hypersecretory states (e.g. Zollinger-Ellison syndrome), may cause multiple ulcers, from the esophagus up to the jejunum."}]}
{"ops":[{"insert":"Drug history - Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)"},{"insert":"\n"}]}
{"ops":[{"insert":"NSAID use is the second major cause of peptic ulcer disease. Pathogenesis of mucosal disruption and subsequent ulceration seems to rely mostly on the inhibition of cyclo-oxygenase-1 (COX-1), an enzyme present in gastrointestinal epithelium, leading to a decrease in prostaglandin secretion, which are important mediators in mucosal protection.\nConcomitant inhibition of cyclo-oxygenase-2 (COX-2), an isoenzyme induced by inflammation, may also play a role in this process."}]}
{"ops":[{"insert":"Drug history - Other drugs"},{"insert":"\n"}]}
{"ops":[{"insert":"A detailed medication history should be obtained especially in elderly patients, including antiplatelet drugs, warfarin, selective serotonin reuptake inhibitors, and bisphosphonates, steroids, potassium chloride and chemotherapeutic agents (e.g., intravenous fluorouracil)."}]}
{"ops":[{"insert":"Social history"},{"insert":"\n"}]}
{"ops":[{"insert":"Little evidence shows the association between alcohol, illegal drug use, stress, and social deprivation and PUD. Smoking seems to be associated with increased risk of duodenal ulcers, in presence of Helicobacter pylori infection."}]}
{"ops":[{"insert":"Introduction"},{"insert":"\n"}]}
{"ops":[{"insert":"A peptic ulcer is an open sore (ulcer), in the lining of the stomach or proximal duodenum, caused by pepsin and gastric acid secretion (peptic). Occasionally, peptic ulcer disease (PUD) may also occur in the esophagus, distal duodenum or jejunum."}]}
{"ops":[{"insert":"Dyspepsia"},{"insert":"\n"}]}
{"ops":[{"insert":"Patients may present with dyspepsia of at least 1 month, characterized by gnawing or burning epigastric pain occurring post meals (within 2 to 5 hours) or on an empty stomach, and may awaken the patient at night. It is relieved by food intake, antacids, or antisecretory agents since it counterbalances acid secretion by the stomach.\nPersisting pain suggests gastric wall penetration.\nSevere, persistent and spreading upper abdominal pain suggests perforation."}]}
{"ops":[{"insert":"Epigastric fullness"},{"insert":"\n"}]}
{"ops":[{"insert":"Sensation caused by dysfunction of gastric motor function, either by delayed or by rapid gastric emptying, with consequent distension of the proximal duodenum.\nMucosal inflammation, irritation and\/or spasm may contribute to this process. When chronic ulcers occur, this leads to stenosis, scarring, and fibrosis, such as in gastric outlet obstruction and gastric cancer."}]}
{"ops":[{"insert":"Nausea and vomiting"},{"insert":"\n"}]}
{"ops":[{"insert":"Nausea and vomiting may also accompany the presentation. These complaints are particularly prominent in individuals with gastric outlet obstruction, a complication of PUD (see below), in which marked inflammation and obstruction are present."}]}
{"ops":[{"insert":"Heartburn (pyrosis)"},{"insert":"\n"}]}
{"ops":[{"insert":"Heartburn may occur in cases of intercurrent gastroesophageal reflux or other hypersecretory states (e.g. Zollinger-Ellison syndrome, gastric outlet obstruction). It results from irritation produced by contact of the acidic gastric contents with the esophageal mucosa."}]}
{"ops":[{"insert":"Loss of appetite (anorexia) and weight loss"},{"insert":"\n"}]}
{"ops":[{"insert":"Anorexia and weight loss may be caused by fear of food intake. It can also be associated with more serious disease, such as cancer."}]}
{"ops":[{"insert":"Hematemesis and\/or melena"},{"insert":"\n"}]}
{"ops":[{"insert":"May occur in case of ulcer bleeding, either acute or subacute."}]}
{"ops":[{"insert":"Asymptomatic"},{"insert":"\n"}]}
{"ops":[{"insert":"It has been found that at least 30% of older patients do not present with abdominal pain or have less intense pain than younger patients when they have an ulcer.\nAdditionally, individuals with intercurrent splanchnic hypoperfusion (e.g. critical illness, hypovolemia), may have silent stress ulcers."}]}
{"ops":[{"insert":"Past medical history - Helicobacter pylori infection"},{"insert":"\n"}]}
{"ops":[{"insert":"Being the major cause of peptic ulcer disease, it should be ascertained in every patient. It might be useful to address previous diagnosis of Helicobacter pylori infection, mainly if left untreated, or if no test of cure is documented."}]}
{"ops":[{"insert":"Past medical history - Other comorbidities"},{"insert":"\n"}]}
{"ops":[{"insert":"Other infections have been described as increasing the risk of PUD (tuberculosis, cytomegalovirus).\nComorbidities described as risk factors for PUD include past history of PUD, Crohn\u2019s disease, hepatic cirrhosis chronic renal failure, sarcoidosis, myeloproliferative disorders, critical illness and some cancers (gastric, lung and lymphomas).\nRarely, hypersecretory states (e.g. Zollinger-Ellison syndrome), may cause multiple ulcers, from the esophagus up to the jejunum."}]}
{"ops":[{"insert":"Drug history - Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)"},{"insert":"\n"}]}
{"ops":[{"insert":"NSAID use is the second major cause of peptic ulcer disease. Pathogenesis of mucosal disruption and subsequent ulceration seems to rely mostly on the inhibition of cyclo-oxygenase-1 (COX-1), an enzyme present in gastrointestinal epithelium, leading to a decrease in prostaglandin secretion, which are important mediators in mucosal protection.\nConcomitant inhibition of cyclo-oxygenase-2 (COX-2), an isoenzyme induced by inflammation, may also play a role in this process."}]}
{"ops":[{"insert":"Drug history - Other drugs"},{"insert":"\n"}]}
{"ops":[{"insert":"A detailed medication history should be obtained especially in elderly patients, including antiplatelet drugs, warfarin, selective serotonin reuptake inhibitors, and bisphosphonates, steroids, potassium chloride and chemotherapeutic agents (e.g., intravenous fluorouracil)."}]}
{"ops":[{"insert":"Social history"},{"insert":"\n"}]}
{"ops":[{"insert":"Little evidence shows the association between alcohol, illegal drug use, stress, and social deprivation and PUD. Smoking seems to be associated with increased risk of duodenal ulcers, in presence of Helicobacter pylori infection."}]}

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