A peptic ulcer is a sore or hole in the lining of the stomach or duodenum and is a term used to describe a lesion in the esophagus, stomach, or duodenum. More specific names are used to describe an ulcer located at a specific site. Duodenal ulcers (the first part of the small intestine) are more common than other types of peptic ulcers. Peptic ulcers are caused by hypersecretion of hydrochloric acid and pepsin that erode the GI mucosal lining.
Anyone can get an ulcer. Most ulcers are caused by an infection with the bacterium Helicobacter pylori—not spicy food, acid, or stress—and can be cured with antibiotics in about two weeks. The most common ulcer symptom is burning pain in the stomach: V2-IV2 hours after eating with gastric ulcers; 2-3 hours for a duodenal ulcer.
Gastric secretions in the stomach maintain a pH between 2 and 5. Pepsin, a digestive enzyme, activates at pH 2 and the acid-pepsin complex of gastric secretions cause mucosal damage. If gastric secretions increase to pH 5, pepsin declines. The gastric mucosal barrier (GMB) is a thick, viscous, mucous lining and is a defense against corrosive substances. The two sphincter muscles— cardiac and pyloric—act as barriers to prevent reflux of acid into the esophagus and the duodenum. Esophageal ulcers result from reflux of acidic gastric secretion into the esophagus as a result of a defective or incompetent cardiac sphincter.
Gastric ulcers frequently occur because of a breakdown of the GMB.
Duodenal ulcers are caused by hypersecretion of acid from the stomach that passes to the duodenum because of
• insufficient buffers to neutralize the gastric acid in the stomach.
• a defective or incompetent pyloric sphincter.
• hypermotility of the stomach.
Treatment of peptic ulcers is given in two-drug, three-drug, and four-drug regimens, or a combination medication consisting of multiple drugs combined into one package.
However, the American College of Gastroenterology no longer recommends two-drug regimens since they are not as effective as other treatment regimens. The different classes of medication that may be combined are listed below.
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