Peptic Ulcers

Welcome to PT 635 Pathophysiology of Complex Patient Problems This is a wiki created by and for the students in the School of Physical Therapy at Bellarmine University in Louisville KY. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!

Original Editors -Emily Hays from Bellarmine University's Pathophysiology of Complex Patient Problems project.

Lead Editors - Your name will be added here if you are a lead editor on this page.  Read more.

Description

Peptic ulcers are the result of deterioration of the mucosal lining of the stomach and duodenum that can lead to damage of the gastrointestinal tissue. Pepsin, a catalytic enzyme that assists in protein breakdown, increases the gastric acidity in the stomach and assists in digestion. This production of excessive acid can overwhelm the protective lining of mucus within the stomach and duodenum. The stomach tissue cannot handle the acidity and begins to erode.

There are three classifications of Peptic Ulcer:

• Stomach
  
• Duodenal
  
• Stress
  

Prevalence/Incidence

According to the National Institute of Health, one in 10 Americans will suffer an ulcer. Over 500 million people are newly diagnosed each year while 4 million cases reported are recurrent. Although ulcers can occur at any age, including infancy, stomach ulcers are more common after 60 years of age and are typically seen more in women than men. Duodenal ulcers are more commonly seen during the third and fifth decades and effect men more than women. Stress Ulcers have not been identified to be more prominent at any age, but rather more apparent in high stress living environments and those individuals who have suffered from a trauma such as a burn or gastrointestinal surgery.

Causes

Ulcerations can occur due to a bacterial infection of the mucosal lining of the stomach. Helicobacter pylori more commonly known as H. Pylori, causes an overproduction of stomach acid which can overpower the membranes and cause a breakdown of the stomach lining.

Peptic ulcers can occur with prolonged NSAIDs use, hiatal hernia, vitamin deficiency such as folic acid and vitamin C can also cause an imbalance of gastric juices which can make the stomach susceptible to erosion. Other research suggests that ulcers are a side effect psychological stress and are more prominent in individuals with poor coping skills.

Characteristics

Three stages of ulceration have been identified. Erosion is the first stage where a marked destruction of the mucosal lining approximately 1-2 cm across. If not addressed a true ulcer can emerge which can be identified by marked disruption of the smooth tissue in the stomach and duodenum. The final and most life threatening stage is a bleeding ulcer. This type of ulcer is a partial or complete hole in the stomach tissue causing hemorrhage. This condition is a medical emergency and can cause significant GI complications.

Associated Co-morbidities

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Clinical Presentation

Symptoms can easily be dismissed during a physical therapy evaluation if not directly asked to the patient since some symptoms may feel unrelated to the patient. A patient may present with low back pain that they cannot identify specifically to an event or particular injury. When prompted, the patient may be able to assess their pain characteristics as a dull or gnawing ache that can occur usually 1-3 hrs after eating. The pain can be intermittent but usually consistent for a period of time until digestion is complete. Patients may report that pain can be alleviated with eating a small amount of food or taking an antacid, but will return after a full meal. Severe ulceration can cause a blockage and does not allow food to move from the stomach to the duodenum. This typically causes significant pain, nausea and vomiting.
Additional Symptoms include:

• GERD
• Weight loss
• Bloating/distended stomach
• Burping
• Feeling of fullness/poor appetite

Medications

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Diagnostic Tests/Lab Tests/Lab Values

• Upper GI: Series of x-rays of the GI tract including the esophagus, stomach and duodenum. The patient will need to ingest a barium solution which allows these structures to be viewed by a radiologist with more clarity.
• Endoscopy: this is a procedure using a thin tube connected to a lit camera which is inserted through the mouth into esophagus and allows a physician to see an ulcer and determine its severity.
• Blood tests can also be performed to determine if a patient has the H. pylori bacterial infection.
  
  

Medical Management (current best evidence)

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Physical Therapy Management (current best evidence)

Although patient education and referral is an important aspect for the physical therapist management; peptic ulcers should be managed by a licensed medical professional such as a general practitioner or gastroenterologist.

Alternative/Holistic Management (current best evidence)

Though life changes are encouraged to limit stress induced ulcers, other homeopathic care includes licorice, vitamin A, vitamin C, banana powder, zinc, garlic, glutamine, and fiber. Comfrey leaves from a perennial shrub have been used since ancient China for the calming of stomach pains. Other treatments include chamomile, marshmallow, and calendula otherwise known as marigolds.

Differential Diagnosis

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Case Studies

  Peptic Ulcer Disease in a General Adult Population

  Effects of Helicobacter pylori and Nonsteroidal Anti-Inflammatory Drugs on Peptic Ulcer Disease: A Systematic Review

Resources

Incidence and Risk Factors for Self-reported Peptic Ulcer Disease in the United States

Prevalence and incidence of peptic ulcer disease in a Danish County a prospective cohort study

Peptic ulcer disease today

Management of Complicated Peptic Ulcer Disease

References

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