PEPTIC ULCER

INTRODUCTION:
A peptic ulcer is erosion in the lining of the stomach or
duodenum (the first part of the small intestine). Pepsin is an enzyme present in
the stomach that breaks down proteins. A peptic ulcer is an ulcer of one of
those areas of the gastrointestinal tract that are usually acidic. Most ulcers
are associated with Helicobacter pylori, a spiral-shaped bacterium that lives in
the acidic environment of stomach. Contrary to general belief, more peptic
ulcers arise in the duodenum, than in the stomach. About 4% of stomach ulcers
are caused by a malignant tumor, so multiple biopsies are needed to make sure.
Duodenal ulcers are generally benign.

CLASSIFICATION:
A peptic ulcer may arise at various locations: The ulcer
caused in the Stomach is called gastric ulcer. The ulcer of the Duodenum is
called duodenal ulcer and Esophagus is called esophageal ulcer.

SYMPTOMS:
Generally the symptoms of a peptic ulcer can be: abdominal pain,
classically epigastric with severity relating to mealtimes; bloating and
abdominal fullness, water brash, nausea, and sometimes vomiting, loss of
appetite and weight loss; Hematemesis (vomiting of blood); Melena .Rarely, an
ulcer can lead to a gastric or duodenal perforation. This is extremely painful
and requires immediate surgery. A history of heartburn, gastro esophageal reflux
disease (GERD) and use of certain forms of medication can raise the suspicion
for peptic ulcer.
A gastric ulcer would give epigastric pain during the meal, as gastric acid
is secreted, or after the meal, as the alkaline duodenal contents reflux into
the stomach. Symptoms of duodenal ulcers would manifest mostly before the meal,
when acid (production stimulated by hunger) is passed into the duodenum.

CAUSES:
The direct cause of peptic ulcers is the destruction of the gastric
or intestinal mucosal lining of the stomach by hydrochloric acid, an acid
normally present in the digestive juices of the stomach. Normally the lining of
the stomach and small intestines have protection against the irritating acids
produced in the stomach. For a variety of reasons, the protective mechanisms may
become faulty, leading to a breakdown of the lining. This results in an ulcer.
The most common cause of such damage is infection of the stomach
with a bacterium called Helicobacter pylori (H.pylori). Most people with peptic
ulcers have this organism living in their gastrointestinal (GI) tract. On the
other hand, many people have this organism living in their GI tract but they
don't get an ulcer. Other factors which activate the cause for ulcer, includes
using aspirin, ibuprofen, or naproxen, drinking alcohol excessively and smoking
cigarettes and using tobacco.

DIAGNOSIS:
It is advisable to visit the physician for the diagnosis and seek
medication. To diagnose an ulcer, the doctor will order one of the following
tests:
An upper GI, where a series of x-rays taken after the patient drinks a
substance called barium. An esophago gastroduodenoscopy (EGD) is a special test
performed by a gastroenterologist in which a thin tube is inserted through the
mouth into the gastrointestinal tract to look at the stomach and small
intestines.
During an EGD, the doctor may take a biopsy from the wall of the intestines to
test for H. pylori.
The doctor may also order: Stool guaiac cards to test for blood in the stool
Hemoglobin test to check for anemia.

TREATMENT:
Treatment often involves a combination of medications to kill
the Helicobacter pylori bacteria, reduce acid levels, and protect the GI tract.
This combination strategy allows your ulcer to heal and reduces the chance it
will come back. Take all of your medications exactly as prescribed. If a peptic
ulcer bleeds a lot, an EGD may be needed to stop the bleeding. If bleeding
cannot be stopped using an EGD procedure or the ulcer has caused a perforation,
then surgery may be required.

SELF CARE:
To prevent oneself the severity of ulcer, the patient should
control stress.
Acidic or spicy foods may increase ulcer pain. Stress may increase acid and
slow digestion.
Avoid Smoking as it also increases stomach acid.
Avoid alcohol as the excessive use of alcohol can irritate and erode the
mucous lining in the stomach and intestines, causing inflammation and bleeding.
Avoid non steroidal anti-inflammatory drugs (NSAIDs). If you use pain
relievers regularly, use acetaminophen (Tylenol, others).
Control acid reflux. If the patient has an esophageal ulcer, usually
associated with acid reflux, he should avoid spicy and fatty foods, avoid
reclining after meals for at least three hours, raise the head of the bed and
reduce the weight.

DIET:
The diet is the key for the treatment of peptic ulcer.
Milk, cream, butter, fruits, fresh raw and boiled vegetables, natural foods,
and natural vitamin supplements constitute the best diet.
Hunger denotes acid load, avoid it by taking small meals often.
Avoid full meal, oily diet, pickles and fatty snacks before bed time
Avoid food containing high spices, chilies, pepper, sausages.
Avoid dry bread, cakes and cookies, high fat content nuts and biscuits and
aerated drinks, coffee and tea.

HOME REMEDIES:
Banana is one of the most effective home remedies for the treatment of a
peptic ulcer. It neutralizes the over-acidity of the gastric juices and reduces
the irritation of the ulcer by coating the lining of the stomach. Patients who
are in an advanced state of the disease should take a diet consisting only of
two bananas with a glass of milk, three or four times a day.
An infusion of the leaves of wood apple is another effective remedy for this
disease. Fifteen grams of leaves should be soaked overnight in 250 ml of water.
In the morning this water should be strained and taken as a drink. Bael leaves
are rich in tannins which reduce inflammation and help in the healing of ulcers.
Lime is valuable in peptic ulcers. The citric acid in this fruit, together
with the mineral salts present in the juice, help in digestion.
Cabbage is regarded as another useful home remedy for a peptic ulcer: The
juice extracted from raw cabbage is also a valuable medicine for a peptic ulcer.
A tea made from fenugreek seeds is yet another useful remedy for peptic
ulcers.
The leaves of the kalyana murangal tree, which is a variety 'of drumstick
found in South India, have also proved helpful in the healing of ulcers. Ten
grams of the leaves of this tree should be ground into a paste, mixed with half
a cup of yoghurt, and taken daily.
The juices of raw vegetables, particularly carrot and cabbage, are beneficial
in the treatment of peptic ulcers.
Carrot juice may be taken either alone or in combination with spinach, or
beet and cucumber.
Milk prepared from blanched almonds in a blender is very useful as a treatment
for peptic ulcers. It binds the excess of acid in the stomach and supplies high
quality protein.

HOMEOPATHIC TREATMENT:
Some of the commonly used medicines for
gastritis and duodenal ulcers are argentum-nit, arsenic-alb, atropine, geranium,
hydrastis, kali-bichrom, merc-cor, ornithogalum, phosphorus, uranium-nit,
terebintha, lycopodium, pulsatilla, graphites, natrum-phos, medorrhinum etc.