Peptic ulcer

A raw area that develops in the gastrointestinal tract as a result of erosion by acidic gastric juice; it most commonly occurs in the stomach or the 1st part of the duodenum. The major cause of peptic ulcers is bacterial infection, which can damage the lining of the stomach and duodenum, allowing the acid stomach contents to attack it. Analgesic drugs, alcohol, excess acid production, and smoking can also damage the stomach lining. Ulcers can also form in the oesophagus, when acidic juice from the stomach enters it (see acid reflux), and in the duodenum. There may be no symptoms, or there may be burning or gnawing pain in the upper abdomen. Other possible symptoms include loss of appetite, nausea, and vomiting. The ulcer may also bleed. If severe, it may result in haematemesis (vomiting of blood) and melaena, and is a medical emergency. Chronic bleeding may cause iron-deficiency anaemia. Rarely, an ulcer may perforate the wall of the digestive tract and lead to peritonitis. An ulcer is usually diagnosed by an endoscopy of the stomach and duodenum; less commonly, a barium meal (see barium X-ray examination) is performed. Tests will be carried out to see whether the individual is infected with the bacterium. If this is the case, a combination of antibiotics and an ulcerhealing drug will be given. A further test may be done to check that treatment has been successful. If is not detected – for example, in ulcers caused by nonsteroidal anti-inflammatory drugs (NSAIDs) – treatment is with proton pump inhibitors or H-blockers, and the NSAIDs will be stopped. Surgery is now rarely needed for peptic ulcers, except to treat complications such as bleeding or perforation.


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