Peptic Ulcer

Peptic Ulcer

Liver Cancer

Definition

  • A peptic ulcer is a sore on the lining of your stomach or duodenum. Rarely, a peptic ulcer may develop just above your stomach in your esophagus. Doctors call this type of peptic ulcer an esophageal ulcer

Epidemiology and burden of Peptic Ulcer

  • About 30 to 40 percent of people in the United States get an H. pylori infection. In most cases, the infection remains dormant, or quiet without signs or symptoms, for years. Most people get an H. pylori infection as a child. (Clinical Findings and Mucosal Immune Response. Journal of Pediatric Gastroenterology and Nutrition. Published online July 21, 2014.)
  • In India, the frequencies of both duodenal ulcer and gastric ulcer showed a decline from 1988 to 2008, i.e. from 12 % to 2.9 % and 4.5 % to 2.7 %, respectively (p-value <0.001 for trend for each). The decline was more marked for duodenal ulcer, and the ratio of duodenal to gastric ulcer declined from 2.7 in 1988 to 1.1 in 2008. (Indian Journal of Gastroenterology, June 2012, Volume 31, Issue 3, pp 111–115)
  • The annual incidence rates of PUD is 0.10–0.19% for physician-diagnosed PUD and 0.03–0.17% when based on hospitalization data. The 1-year prevalence based on physician diagnosis is 0.12–1.50% and that based on hospitalization data was 0.10–0.19%. (Aliment Pharmacol Ther.2009 May 1;29(9):938-46)
  • Peptic ulcer disease (PUD) is an important cause of morbidity and health care costs; estimates of expenditures related to work loss, hospitalization, and outpatient care (excluding medication costs) are $5.65 billion per year in the United States(http://www.uptodate.com/contents/epidemiology-and-etiology-of-peptic-ulcer-disease)

Treatment for Peptic Ulcer

  • Standard therapy consisting of a proton pump inhibitor (PPI), clarithromycin (C) and amoxicillin (A) is usually used as the first-line regimen for peptic ulcer with H. Pylori infection.(Am J Gastroenterol. 2001 Jan;96(1):58-62)
  • OBMT (omeprazole, bismuth biskalcitrate, metronidazole, and tetracycline) regimen using the single-triple capsule is as efficacious and well-tolerated as the widely used OAC regimen for H. pylori eradication. This OBMT therapy largely overcomes H. pylori metronidazole resistance, present in 40% of patients in this study.(Am J Gastroenterol. 2003 Mar;98(3):562-7)
  • Omeprazole 10 mg has similar efficacy in maintaining symptomatic remission as rabeprazole 10 mg, but is superior to rabeprazole 10 mg in terms of cost efficiency in the maintenance therapy of gastroesophageal reflux disease symptoms.(J Neurogastroenterol Motil. 2013 Apr;19(2):219-26)
  • Probiotics supplementation (itopride 50 mg thrice daily, pantoprazole 40 mg, amoxicillin 1 gm and clarithromycin 500 mg twice daily for 2 weeks) increases eradication rates of anti H. pylori therapy and improves tolerability by reducing side effects especially diarrhoea. Prokinetics and probiotic based novel regimen improved dyspepsia symptoms and patient compliance.(Int J Basic Clin Pharmacol. 2016; 5(1): 173-179

Prevention of Peptic Ulcer

  • Red wine and green tea are able to prevent H pylori-induced gastric epithelium damage, possibly involving VacA inhibition. (World J Gastroenterol. 2007 Jan 21; 13(3): 349–354)
  • High doses of vitamin C inhibit the growth of H. pylori in vitro as well as in vivo. (Cancer.1997 Nov 15;80(10):1897-903)
  • The incidence of UGI ulcer complications associated with celecoxib was 8-fold lower than with nonspecific NSAIDs. (Am J Gastroenterol.2000 Jul;95(7):1681-90)

Risk factors for Peptic Ulcer

  • High body mass index [body mass index (BMI) 25-30: OR, 1.5, 95% CI: 1.0-2.2; BMI > 30 kg/m2: OR, 3.6, 95% CI: 1.5-8.7] and current smoker (OR, 2.6, 95% CI: 1.6-4.4) are independent predictors of asymptomatic PUD. (World J Gastroenterol. 2011 Mar 7; 17(9): 1199–1203)
  • pylori infection (OR: 1.70, 95% CI: 1.03-2.89), meat (OR: 1.10, 95% CI: 1.02-1.75), fish (OR: 1.05, 95% CI: 1.02-1.89) consumption, and a family history of ulcer (OR: 1.20, 95% CI: 1.08-1.60) are risk factors for peptic ulcer. Consumption of chili peppers (OR: 0.20, 95% CI: 0.10-0.37) and parasite infestation (OR: 0.44, 95% CI: 0.24-0.80) are protective against H. pylori infection. (J Glob Infect Dis.2013 Apr;5(2):60-7)
  • In patients with increased antibodies to H pylori, tobacco smoking (12.7 (2.8; 56.8)) and intake of spirits (2.4 (1.1; 5.4)) increased the risk of PUD whereas moderate leisure time physical activity (0.3 (0.2; 0.7)) protected against PUD. (2003 Feb;52(2):186-93)
  • Diabetes is independently associated with increased risk of PUB (hazard ratio 1.44, 95% confidence interval 1.11-1.86; P < 0.001). (J Gastroenterol Hepatol.2013 Aug;28(8):1295-9)
  • The incidence of PUD was 2-fold higher in the depression cohort than in the comparison cohort (33.2 vs 16.8 per 1000 person-years) with an age adjusted HR of 1.97 (95% CI = 1.89–2.06) or a multivariable adjusted HR of 1.35 (95% CI = 1.29–1.42). (Medicine (Baltimore).2015 Dec;94(51))

Systematic reviews

  • Meta-analysis of risk factors for peptic ulcer. Nonsteroidal antiinflammatory drugs, Helicobacter pylori, and smoking..more
  • Acid suppression in peptic ulcer haemorrhage: a ‘meta-analysis’..more
  • Intravenous H2-receptor antagonists are of no value in bleeding duodenal ulcer, although they may be mildly beneficial in bleeding gastric ulcer..more
  • Effect of comorbidity on mortality in patients with peptic ulcer bleeding..more

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