What is Peptic Ulcer Disease?Peptic Ulcer Disease [PUD] is a misnomer. In early 20th century it was believed that the ulcer of stomach and duodenum [First part of small intestine, just after stomach] was caused by gastric enzyme Pepsin and thus it was started to be called as peptic ulcer disease.
Basically, peptic ulcer disease is a pathological condition with formation of ulcers either in stomach or in duodenum. Duodenal ulcers are 4 times more common than gastric [stomach] ulcers. Another important distinction between gastric ulcers and duodenal ulcer is that around 4-5 percent of stomach ulcers can be due to malignant tumor, thus justifying multiple biopsies to rule out any carcinogenic origin. Duodenal ulcers are most of the time benign and does not require multiple biopsies.
Signs & Symptoms of Peptic Ulcer Disease
Symptoms of peptic ulcers gives an important clue towards diagnosis of the disease. Though, these signs and symptoms are not enough to distinguish between Gastric or duodenal ulcers or even the diagnosis of ulcer alone.
Nausea & Vomiting is present in both gastric and duodenal ulcers.
Most common presentation of Peptic ulcer is mid-epigastric pain. The pain of stomach ulcers usually increases with food , while in duodenal ulcers usually the midepigastric pain decreased after taking food.
Weight loss is also associated with peptic ulcer disease. Since pain of gastric ulcer increases with the intake of food they are more likely to cause increase in weight loss when compared to duodenal ulcers where pain is relieved after having a meal.
Tenderness of abdomen is usually not present in almost 80-85 percent of cases of peptic ulcer disease, until the ulcer has caused perforation.
Other important symptoms might include hematemesis [Vomiting of blood] or malena [ black colored or tarry stools due to oxidation of iron in hemoglobin]
The above signs and symptoms are not enough to distinguish between gastric and duodenal ulcers and the patient might need and endoscopy or special imaging technique like barium swallow or upper gastrointestinal series.
There can be many causes of peptic ulcer and some special techniques can be required for proper diagnosis and treatment of peptic ulcer disease which we will discuss in detail in subsequent articles.