Peptic Ulcer Disease (PUD) - Gastrointestinal Disorders - Gastritis

What is Peptic Ulcer Disease (PUD)?

A peptic ulcer is a hole in the gut lining of the stomach, duodenum, or esophagus. A peptic ulcer of the stomach is called a gastric ulcer; of the duodenum, a duodenal ulcer; and of the esophagus, an esophageal ulcer.

The two most common causes of peptic ulcer disease are Helicobacter pylori infection and the use of nonsteroidal anti-inflammatory drugs (NSAIDs). As the prevalence of H. pylori infection decreases and NSAID use increases, the relative contribution of each factor to the incidence of peptic ulcer disease (PUD) will change.

What is H. pylori?

Helicobacter pylori (H. pylori) is a type of bacteria. Researchers believe that H. pylori is responsible for the majority of peptic ulcers.

H. pylori infection is common in the United States. About 20 percent of people under 40 years old and half of those over 60 years have it. Most infected people, however, do not develop ulcers. Why H. pylori does not cause ulcers in every infected person is not known. Most likely, infection depends on characteristics of the infected person, the type of H. pylori, and other factors yet to be discovered.

Researchers are not certain how people contract H. pylori, but they think it may be through food or water.

Researchers have found H. pylori in the saliva of some infected people, so the bacteria may also spread through mouth-to-mouth contact such as kissing.

How does H. pylori cause a peptic ulcer?

H. pylori weakens the protective mucous coating of the stomach and duodenum, which allows acid to get through to the sensitive lining beneath. Both the acid and the bacteria irritate the lining and cause a sore, or ulcer.
H. pylori is able to survive in stomach acid because it secretes enzymes that neutralize the acid. This mechanism allows H. pylori to make its way to the "safe" area—the protective mucous lining. Once there, the bacterium's spiral shape helps it burrow through the lining.

Peptic Ulcer Causes



Normally, the lining of the stomach and small intestines are protected against the irritating acids produced in your stomach. If this protective lining stops working correctly, and the lining breaks down, it results in inflammation (gastritis) or an ulcer.

No single cause has been found for ulcers. However, it is now clear that an ulcer is the end result of an imbalance between digestive fluids in the stomach and duodenum. Ulcers can be caused by:

• Infection with a type of bacteria called Helicobacter pylori (H. pylori)
• Use of painkillers called nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, naproxen (Aleve, Anaprox, Naprosyn, and others), ibuprofen (Motrin, Advil, Midol, and others), and many others available by prescription. Even aspirin coated with a special substance can still cause ulcers.
• Excess acid production from gastrinomas, tumors of the acid producing cells of the stomach that increases acid output; seen in Zollinger-Ellison syndrome.
• Drinking too much alcohol
• Smoking cigarettes or chewing tobacco
• Being very ill, such as being on a breathing machine
• Radiation treatments
• Stress. Although stress per se isn't a cause of peptic ulcers, it's a contributing factor.
  

A rare condition called Zollinger-Ellison syndrome causes stomach and duodenal ulcers. Persons with this disease have a tumor in the pancreas that releases high levels of a hormone, which causes an increase in stomach acid.

Depending on their location, peptic ulcers have different names:

1. Gastric ulcer. This is a peptic ulcer that occurs in your stomach.
2. Duodenal ulcer. This type of peptic ulcer develops in the first part of the small intestine (duodenum).
3. Esophageal ulcer. An esophageal ulcer is usually located in the lower section of your esophagus. It's often associated with chronic gastroesophageal reflux disease (GERD).
   

Peptic Ulcer Symptoms

Small ulcers may not cause any symptoms. Some ulcers can cause serious bleeding.

Abdominal pain is a common symptom but it doesn't always occur. The pain can differ a lot from person to person.

* Feeling of fullness -- unable to drink as much fluid
* Hunger and an empty feeling in the stomach, often 1 - 3 hours after a meal
* Mild nausea (vomiting may relieve symptom)
* Pain or discomfort in the upper abdomen
* Upper abdominal pain that wakes you up at night

Other possible symptoms include:

* Bloody or dark tarry stools
* Chest pain
* Fatigue
* Vomiting, possibly bloody
* Weight loss
* Heartburn

Peptic Ulcer Exams and Tests / Peptic Ulcer Diagnosis

To diagnose an ulcer, your doctor will order one of the following tests:

1. Esophagogastroduodenoscopy (EGD) is a special test performed by a gastroenterologist in which a thin tube with a camera on the end is inserted through your mouth into the GI tract to see your stomach and small intestine. During an EGD, the doctor may take a biopsy from the wall of your stomach to test for H. pylori.
2. Upper gastrointestinal (upper GI) X-ray. Upper GI is a series of x-rays taken after you drink a thick substance called barium.
3. Hemoglobin blood test to check for anemia
4. Stool antigen test. This test checks for H. pylori in stool samples. It's useful both in helping to diagnose H. pylori infection and in monitoring the success of treatment.
5. Breath test. This procedure uses a radioactive carbon atom to detect H. pylori. The advantage of the breath test is that it can monitor the effectiveness of treatment used to eradicate H. pylori, detecting whether the bacteria have been killed or eradicated.
   

Peptic Ulcer Treatment

Treatment involves a combination of medications to kill the H. pylori bacteria (if present), and reduce acid levels in the stomach. This strategy allows your ulcer to heal and reduces the chance it will come back.

Take all of your medications exactly as prescribed.

If you have a peptic ulcer with an H. pylori infection, the standard treatment uses different combinations of the following medications for 5 - 14 days:

• Two different antibiotics to kill H. pylori, such as clarithromycin (Biaxin), amoxicillin, tetracycline, or metronidazole (Flagyl)
• Proton pump inhibitors such as omeprazole (Prilosec), lansoprazole (Prevacid), or esomeprazole (Nexium)
• Bismuth (the main ingredient in Pepto-Bismol) may be added to help kill the bacteria
  

If you have an ulcer without an H. pylori infection, or one that is caused by taking aspirin or NSAIDs, your doctor will likely prescribe a proton pump inhibitor for 8 weeks.

You may also be prescribed this type of medicine if you must continue taking aspirin or NSAIDs for other health conditions.

Other medications that may be used for ulcer symptoms or disease are:

• Misoprostol, a drug that may help prevent ulcers in people who take NSAIDs on a regular basis
• Medications that protect the tissue lining (such as sucralfate)
  

If a peptic ulcer bleeds a lot, an EGD may be needed to stop the bleeding. Surgery may be needed if bleeding cannot be stopped with an EGD, or if the ulcer has caused a perforation.

Peptic Ulcer Outlook (Prognosis)

Peptic ulcers tend to come back if untreated. If you follow your doctor's treatment instructions and take all of your medications as directed, the H. pylori infection will be cured and you'll be much less likely to get another ulcer.

Peptic Ulcer Prevention

Avoid aspirin, ibuprofen, naproxen, and other NSAIDs. Try acetaminophen instead. If you must take such medicines, talk to your doctor first. Your doctor may:

• Test you for H. pylori first
• Have you take proton pump inhibitors (PPIs) or an acid blocker
• Have you take a drug called Misoprostol
  

The following lifestyle changes may help prevent peptic ulcers:

• Do not smoke or chew tobacco.
• Limit alcohol to no more than two drinks per day.
• Avoid nonsteroidal anti-inflammatory drugs (NSAIDs).
• Control acid reflux. If you have an esophageal ulcer — usually associated with acid reflux — you can take several steps to help manage acid reflux.
  

Synonyms and Keywords

aspirin, bleeding ulcer, bowel obstruction, digestive diseases, digestive tract, stomach ulcers, dual therapy, duodenal ulcers, duodenum, fecal-oral transmission, gastric ulcers, gastrointestinal tract, GI tract, Helicobacter pylori, H pylori, H pylori infection, intestinal bleeding, intestinal erosion, intestinal obstruction, intestinal perforation, mucous membranes, mucus, gastric juice, stomach acid, abdominal pain, hydrochloric acid, nonsteroidal anti-inflammatory drugs, NSAIDs, peptic ulcer disease, PUD, small intestine, stomach, triple therapy, pepsin, vagotomy, antrectomy, ulcer, ulcers, peptic ulcer, peptic ulcers

resource: medlineplus

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Irritable Bowel Syndrome (IBS)- Causes, Symptoms, Diagnosis, and Treatment

Irritable bowel syndrome (IBS or spastic colon) is a functional bowel disorder characterized by chronic abdominal pain, discomfort, bloating, constipation, diarrhea, gas, and alteration of bowel habits in the absence of any detectable organic cause. In some cases, the symptoms are relieved by bowel movements.

Irritable Bowel Syndrome Causes

The cause of irritable bowel syndrome is currently unknown. Triggers for IBS can range from gas or pressure on your intestines to certain foods, medications or emotions. For example:

* from an interplay of abnormal gastrointestinal (GI) tract movements
* increased awareness of normal bodily functions
* a change in the nervous system communication between the brain and the GI tract. * Abnormal movements of the colon, whether too fast or too slow, are seen in some, but not all, people who have IBS.
* Hormones. Because women are twice as likely to have IBS, researchers believe that hormonal changes play a role in this condition. Many women find that signs and symptoms are worse during or around their menstrual periods.
* Foods. For instance, chocolate, milk and alcohol might cause constipation or diarrhea. Carbonated beverages and some fruits and vegetables may lead to bloating and discomfort in some people with IBS. The role of food allergy or intolerance in irritable bowel syndrome has yet to be clearly understood.

Irritable bowel syndrome has also developed after episodes of gastroenteritis.

It has been suggested that IBS is caused by dietary allergies or food sensitivities, but this has never been proven.

Irritable Bowel Syndrome Symptoms

Irritable bowel syndrome affects each person differently. The hallmark of IBS is abdominal discomfort or pain. The following symptoms are also common:

* Abdominal cramping and pain that are relieved after bowel movements

* Alternating periods of diarrhea and constipation

* Change in the stool frequency or consistency

* Gassiness (flatulence)

* Passing mucus from the rectum

* Bloating

* Abdominal distension

The following are not symptoms or characteristics of IBS:

* Blood in stools or urine

* Vomiting (rare, though may occasionally accompany nausea)

* Pain or diarrhea that interrupts sleep

* Fever

* Weight loss

Irritable Bowel Syndrome Diagnosis and Tests

You must have certain signs and symptoms before a doctor diagnoses irritable bowel syndrome. The most important are abdominal pain and discomfort lasting at least 12 weeks, though the weeks don't have to occur consecutively. You also need to have at least two of the following:

* A change in the frequency or consistency of your stool — for example, you may change from having one normal, formed stool every day to three or more loose stools daily, or you may have only one hard stool every three to four days
* Straining, urgency or a feeling that you can't empty your bowels completely
* Mucus in your stool
* Bloating or abdominal distension

Your doctor may recommend several tests, including stool studies to check for infection or malabsorption problems. Among the tests that you may undergo to rule out other causes for your symptoms are the following:

* Flexible sigmoidoscopy. This test examines the lower part of the colon (sigmoid) with a flexible, lighted tube (sigmoidoscope).

* Computerized tomography (CT) scan. CT scans produce cross-sectional X-ray images of internal organs. CT scans of your abdomen and pelvis may help your doctor rule out other causes of your symptoms.

* Lactose intolerance tests. Lactase is an enzyme you need to digest the sugar found in dairy products. If you don't produce this enzyme, you may have problems similar to those caused by irritable bowel syndrome, including abdominal pain, gas and diarrhea. To find out if this is the cause of your symptoms, your doctor may order a breath test or ask you to exclude milk and milk products from your diet for several weeks.

* Blood tests. Celiac disease (nontropical sprue) is sensitivity to wheat protein that also may cause signs and symptoms like those of irritable bowel syndrome. Blood tests may help rule out that disorder.



* Esophagogastroduodenoscopy (Also called EGD or upper endoscopy.) - a procedure that allows the physician to examine the inside of the esophagus, stomach, and duodenum. A thin, flexible, lighted tube, called an endoscope, is guided into the mouth and throat, then into the esophagus, stomach, and duodenum. The endoscope allows the physician to view the inside of this area of the body, as well as to insert instruments through a scope for the removal of a sample of tissue for biopsy (if necessary).

* Abdominal X-Rays - a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.

* Abdominal Ultrasound - a diagnostic imaging technique which uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function, and to assess blood flow through various vessels. Gel is applied to the area of the body being studied, such as the abdomen, and a wand called a transducer is placed on the skin. The transducer sends sound waves into the body that bounce off organs and return to the ultrasound machine, producing an image on the monitor. A picture or video tape of the test is also made so it can be reviewed in the future.



* Colonoscopy - a procedure that allows the physician to view the entire length of the large intestine, and can often help identify abnormal growths, inflamed tissue, ulcers, and bleeding. It involves inserting a colonoscope, a long, flexible, lighted tube, in through the rectum up into the colon. The colonoscope allows the physician to see the lining of the colon, remove tissue for further examination, and possibly treat some problems that are discovered.

Irritable Bowel Syndrome Treatment

Home Remedies

* Experiment with fiber. When you have irritable bowel syndrome, fiber can be a mixed blessing. Although it helps reduce constipation, it can also make gas and cramping worse. The best approach is to gradually increase the amount of fiber in your diet over a period of weeks. Examples of foods that contain fiber are whole grains, fruits, vegetables and beans.

* Avoid problem foods. Common culprits include alcohol, chocolate, caffeinated beverages such as coffee and sodas, medications that contain caffeine, dairy products, and sugar-free sweeteners such as sorbitol or mannitol. If gas is a problem for you, foods that might make symptoms worse include beans, cabbage, cauliflower and broccoli. Fatty foods may also be a problem for some people. Chewing gum or drinking through a straw can lead to swallowing air, causing more gas.

* Eat at regular times. Don't skip meals, and try to eat about the same time each day to help regulate bowel function. If you have diarrhea, you may find that eating small, frequent meals makes you feel better. But if you're constipated, eating larger amounts of high-fiber foods may help move food through your intestines.

* Take care with dairy products. If you're lactose intolerant, try substituting yogurt for milk. Or use an enzyme product to help break down lactose. Consuming small amounts of milk products or combining them with other foods also may help. In some cases, though, you may need to eliminate dairy foods completely. If so, be sure to get enough protein, calcium and B vitamins from other sources.

* Drink plenty of liquids. Try to drink plenty of fluids every day. Water is best. Alcohol and beverages that contain caffeine stimulate your intestines and can make diarrhea worse, and carbonated drinks can produce gas.

* Exercise regularly. Exercise helps relieve depression and stress, stimulates normal contractions of your intestines and can help you feel better about yourself. If you've been inactive, start slowly and gradually increase the amount of time you exercise. If you have other medical problems, check with your doctor before starting an exercise program.

* Use anti-diarrheal medications and laxatives with caution. If you try over-the-counter anti-diarrheal medications, such as Imodium or Kaopectate, use the lowest dose that helps. Imodium may be helpful if taken 20 to 30 minutes before eating, especially if you know that the food planned for your meal is likely to cause diarrhea. In the long run, these medications can cause problems if you don't use them appropriately. The same is true of laxatives. If you have any questions about them, check with your doctor or pharmacist.

Medical Treatment

Most people with irritable bowel syndrome have problems only occasionally. A few may experience long-lasting problems and require prescription medications.

* Fiber supplements. Taking fiber supplements, such as psyllium (Metamucil) or methylcellulose (Citrucel), with fluids may help control constipation. This theoretically expands the inside of the digestive tract, reducing the chance it will spasm as it transmits and digests food. Fiber also promotes regular bowel movements, which helps reduce constipation. Fiber should be added gradually, because it may initially worsen bloating and gassiness.

* Stress may cause IBS "flares." Doctors may offer specific advice on reducing stress. Regularly eating balanced meals and exercising may help reduce stress and problems associated with irritable bowel syndrome.

* Smoking may worsen symptoms of IBS, which gives smokers another good reason to quit.

* Since many patients with irritable bowel syndrome report food intolerances, a food diary may help identify foods that seem to make IBS worse.

Medications

* Antispasmodic medicines, such as dicyclomine (Bemote, Bentyl, Di-Spaz) and hyoscyamine (Levsin, Levbid, NuLev), are sometimes used to treat symptoms of irritable bowel syndrome. Antispasmodic medicines help slow the action of the digestive tract and reduce the chance of spasms. However, they may have some side effects and thus are not for everyone. Other treatment plans are available, depending on symptoms and condition.

* Antidiarrheal medicines, such as loperamide (Imodium), a kaolin/pectin preparation (Kaopectate), and diphenoxylate/atropine (Lomotil), are sometimes used when diarrhea is a major feature of IBS. Do not take these on a long-term basis without first consulting a doctor.

* Antidepressants may be very effective in smaller doses than those typically used to treat depression. Imipramine (Tofranil), amitriptyline (Elavil), nortriptyline (Pamelor), and desipramine (Norpramin) are some commonly used medicines that may alleviate irritable bowel syndrome symptoms. Some other antidepressants are more commonly prescribed when depression and IBS coexist.

* Anticholinergic medications. Some people need medications that affect certain activities of the autonomic nervous system (anticholinergics) to relieve painful bowel spasms. These may be helpful for people who have bouts of diarrhea, but can worsen constipation.

* Antibiotics. It's unclear what role, if any, antibiotics might play in treating IBS. Some people whose symptoms are due to an overgrowth of bacteria in their intestines may benefit from antibiotic treatment. But more research is needed.

Alternative medicine

The following nontraditional therapies may help relieve symptoms of irritable bowel syndrome:

* Acupuncture. Although study results on the effects of acupuncture on symptoms of irritable bowel syndrome have been mixed, some people use acupuncture to help relax muscle spasms and improve bowel function.

* Herbs. Peppermint is a natural antispasmodic that relaxes smooth muscles in the intestines. Peppermint may provide short-term relief of IBS symptoms, but study results have been inconsistent. If you'd like to try peppermint, be sure to use enteric-coated capsules. Peppermint may aggravate heartburn. Before taking any herbs, check with your doctor to be sure they won't interact or interfere with other medications you may be taking.

* Hypnosis. Hypnosis may reduce abdominal pain and bloating. A trained professional teaches you how to enter a relaxed state and then guides you in relaxing your abdominal muscles.

* Probiotics. Probiotics are "good" bacteria that normally live in your intestines and are found in certain foods, such as yogurt, and in dietary supplements. It's been suggested that people with irritable bowel syndrome may not have enough good bacteria, and that adding probiotics to your diet may help ease your symptoms. Some studies have found that probiotics may relieve symptoms of IBS, such as abdominal pain and bloating, but more research is needed.

* Regular exercise, yoga, massage or meditation. These can all be effective ways to relieve stress. You can take classes in yoga and meditation or practice at home using books or videos.

Synonyms and Keywords

IBS, inflammatory bowel disease, IBD, IBS flare, IBS flares, nervous bowel, spastic colon, gastrointestinal disorder, GI disorder, gastrointestinal endoscopy, abdominal cramping, abdominal pain, bowel habits, functional bowel disease, mucous colitis, digestive tract, cramping, diarrhea, bloating, gas, gassiness, flatus, flatulence, constipation, antispasmodic medication, antidiarrheal medication, antidepressants, dicyclomine, Bemote, Bentyl, Di-Spaz, tegaserod, Zelnorm, alosetron, Lotronex, irritable bowel syndrome, anatomy of the digestive tract, anatomy of the digestive system, chronic gastrointestinal disorder, chronic GI disorder, symptoms of IBS, symptoms of irritable bowel syndrome, IBS symptoms, IBS treatment, treatment of IBS

Source:
- emedicinehealth
- Mayo Clinic

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