Acid Peptic Disease: Causes, Symptoms, Diagnosis, and Treatment Guide

Acid Peptic Disease: Causes, Symptoms, Diagnosis, and Treatment Guide

Question. Write acid peptic disease under the following headings:

Etiology, Clinical features, Investigations, Treatment

Answer. Excessive secretion of acid and pepsin or a weakened stomach mucosal defence is responsible for damage to the delicate mucosa and the lining of the stomach, esophagus, and duodenum resulting in ulceration which is known as “Acid Peptic Disease”.

“Acid peptic disease” is a collective term used to include many conditions such as gastroesophageal reflux disease (GERD), gastritis, gastric ulcer, duodenal ulcer, esophageal ulcer, Zollinger­Ellison Syndrome (ZES) and Meckel’s diverticular ulcer.

“Understanding acid peptic disease through FAQs: Causes, symptoms, diagnosis, and treatment explained”

Etiology of acid peptic disease

• Helicobacter pylori: H.pylori is responsible for around 60–90% of all gastric and duodenal ulcers.
• NSAIDs: Prostaglandins protect the mucus lining of the stomach. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, diclofenac, and naproxen prevent the production of these prostaglandins by blocking the cyclooxygenase enzyme leading to ulceration and bleeding.
• Smoking, alcohol, and tobacco: Cigarettes, alcohol, and tobacco cause an instant and intense acid production which acts as though gasoline is poured over a raging fire.
• Blood group O: People with blood group “O” are reported to have higher risks for the development of stomach ulcers as there is an increased formation of antibodies against the Helicobacter bacteria, which causes an inflammatory reaction and ulceration.

“Importance of studying acid peptic disease for healthcare professionals: Questions explained”

• Heredity: Patients suffering from peptic ulcer diseases usually have a family history of the disease, particularly the development of duodenal ulcers which may occur below the age of 20.
• Steroids/other medicines: Drugs like corticosteroids, anticoagulants like warfarin (Coumarin), niacin, some chemotherapy drugs, and spironolactone can aggravate or cause ulcers.
• Diet: A low-fiber diet, caffeinated drinks, and fatty foods are linked to peptic ulcers.
• Other diseases: Chronic liver, lung, and kidney diseases especially tumors of the acid-producing cells all predispose to peptic ulcers. Zollinger­Ellison syndrome (ZES) is a rare pre­cancerous condition that causes peptic ulcer disease.
  Endocrine disorders such as hyperparathyroidism are also implicated in the development of peptic ulcers.
• Stress: Stress and neurological problems can also be associated with Cushing’s ulcer and peptic ulcer.

Clinical Features of Hepatic Amoebiasis

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• Abdominal Pain: A burning pain in the upper part of the abdomen usually related to mealtimes together with fullness, distension of the abdomen, bloating, with or without nausea and generalized discomfort also known as “dyspepsia”. The pain is usually so sharply localized that the patient can often indicate the exact place with two or three fingers called the “pointing sign”. Gastric ulcer pain is more after the ingestion of meals while duodenal ulcer pain occurs more due to hunger.
• Nausea, heartburn, vomiting, loss of appetite, and weight loss.
• Gastric outlet obstruction: The ulcer could heal with scarring and result in narrowing of the gastric or intestinal lumen.
  This could obstruct food from being passed forward.
• Vomiting or passing blood in stool: Signs of bleeding as vomiting of blood or black tarry color of the stool.
• Bleeding and perforation from the ulcer: Bleeding from the site of the ulcer with thinning of the wall may result in perforation.

Investigations of Hepatic Amoebiasis

“Common challenges in diagnosing and treating acid peptic disease effectively: FAQs provided”

• Blood tests: Blood tests such as ELISA help in the measurement of antibodies to H. pylori.
  Serum gastrin levels should be measured in patients with multiple ulcers to consider gastrin-secreting tumors or Zollinger-Ellison syndrome. Tests for gastric secretion include the “pentagastrin test”, the “chew and spit test” and the “Hollander insulin test”.
• Stool Test: The stool test detects the presence of H. pylori in the feces and also establishes whether there is any recurrence after antibiotic therapy.
• Breath test: The urea breath test (UBT) is helpful in the detection of H.pylori.
  The patient is made to drink a liquid containing carbon­labeled urea, which is broken down by the bacteria.
  The patient is subsequently asked to breathe into a sealed bag, which is tested for the presence of labeled carbon.
  A positive test indicates the presence of H pylori infection.
• Endoscopy: Endoscopy is considered a more accurate test for the diagnosis of “peptic ulcer diseases” and also helps in taking a biopsy of the affected area. Gastroscopy or esophagogastroduodenoscopy (EGD) is a kind of endoscopy that is carried out on patients to detect peptic ulcers.
• Barium radiography: X­rays are taken of the stomach, esophagus, and duodenum after swallowing barium and the retention of contrast in the ulcer is monitored.

Treatment of Hepatic Amoebiasis

“Factors influencing success with acid peptic disease knowledge: Q&A”

• Eradication of. pylori: The standard protocol to eradicate pylori involves the use of two or three antibiotics, i.e. amoxicillin, tetracycline, clarithromycin, metronidazole, and the use of a proton pump inhibitor, i.e. esomeprazole, omeprazole, lansoprazole, rabeprazole, pantoprazole with or without a bismuth compound for around 2–3 weeks and repeated if there is recurrence.
• Avoid NSAIDs or the concurrent use of a prostaglandin analog (misoprostol) may be prescribed to prevent peptic ulceration due to NSAIDs.
• The use of antacids or H2 receptor antagonists (H2RAs) such as cimetidine, ranitidine, famotidine, and nizatidine helps in the reduction of gastric acid secretion and in turn, increases the gastric pH and reduces the secretion of pepsin.
• Treatment of peptic ulcer complications includes a blood transfusion for hematemesis and melena, the use of antacids and H 2 receptor antagonists for pain, and the treatment of peritonitis in case of perforation of peptic ulcer disease.