Peptic Ulcers

1. Peptic Ulcers Alma Toric

2. An ulcer is a break or chronic sore in the lining of the stomach or duodenum It can form in any area exposed to gastric acid and pepsin The size of a stomach ulcer can range between 1/8 of an inch to 3/4 of an inch Ulcers are not caused by stress but smoking can have an affect on it Ulcers are most common in adults older than 60. http://www.medem.com/Medem/images/jamaarchives/JAMA_Digestive_Intestinal_Lev20_PepticUlcers_JPP_01.jpg Definition

3. The exact cause of the condition was uncertain until in 1940, Dr. A. Stone Freedberg of Harvard Medical School identified the bacteria in the stomachs of ulcer victims. He abandoned the research when the bacteria was unable to be grown. In the next 40 years doctors treated patients with diet modifications, antacids, and operations. In the early 1980s, two Australian physicians, Dr. Barry J. Marshall and Dr. J. Robin Warren, discovered how to grow the bacteria by trying to infect animals but failed because Helicobacter pylori can only infect humans. Two years later Dr. Marshall developed stomach symptoms by drinking a vial full of bacteria. After another 10 days it showed that his stomach tissue was inflamed and infested with bacteria. Dr. Marshall recovered and continued his research. Dr. A. Stone Freedberg Dr. Barry J. Marshall Dr. J. Robin Warren http://www.isid.org/12th_icid/Images/Marshall.gif http://www.nytimes.com/2005/12/06/health/06docs.html?_r=1&oref=slogin http://www.virginia.edu/insideuva/2005/17/images/marshall.jpg History

4. Helicobacter Pylori (bacteria) present in digestive tract -it is the only bacterium that can survive and thrive in the stomach because it produces an enzyme called urease that synthesizes ammonia -it only needs about a fifth of oxygen to that of human needs -spiral shape helps it burrow through the mucus -it has up to 7 whip like proteins that help it move (like propellers) -it has special receptors to allow to latch onto the stomach cells after getting to the mucus and releases toxins that can cause ulcers -this bacteria colonizes in deep layers of the mucus layer of the stomach -lives in mucous layer, producing chemicals and proteins that can damage the lining -H.Pylori can be transmitted from person to person. http://www.hmiworld.org/hmi/issues/July_Aug_2007/images/Peptic-Ulcers.jpg Causes

5. -produces toxins that encourage white blood cells to make small proteins called cytokines those proteins can enable the inflammatory cycle -the majority of people with this bacteria have no symptoms and are well -but as the bacteria remains over a long period of time a peptic ulcer can develop -it is most common in places with poor hygiene, crowded living, and inadequate sanitation -evidence has linked H.Pylori to other disorders anywhere from iron deficiency anemia to skin and blood problems, to low levels of HDL cholesterol, but more research is needed to prove this http://www.sciencemuseum.org.uk/antenna/cancerkillers/images/cells.jpg http://www.achooallergy.com/blog/images/h_pylori.gif H.Pylori Continued

6. Use of Aspirin, Ibuprofen, and other non-steroidal anti-inflammatory drugs -these drugs erode the stomach lining and are responsible for 25% of gastric ulcers -block production of hormone like substance, prostaglandin, by interfering with enzyme COX(cyclooxygenase) which is needed to make prostaglandin prostaglandin stimulates mucus in stomach, mucous protects lining from acid, COX inhibitors prevent interference In rare cases, a patient will produce very large amounts of acid and develop ulcers. This condition is called Zollinger -Ellison syndrome http://www.nexium.net/gUserFiles/NSAID.gif http://www.getridofthings.com/images/fever-3.jpg Causes

7. -periodic gnawing, burning pain in upper abdomen -bloating and nausea after meals -feeling of hunger -pain often stays for a few days or weeks and disappears for weeks or months -if the ulcer bleeds, maroon-colored stools and vomiting up red or coffee ground material (can cause anemia and fatigue) -loss of appetite -weight loss -pain can be relived by antacids or by vomiting http://www.ok.gov/strongandhealthy/images/Healthy%20Foods.jpg http://www.medofficedirect.com/images/ProductImages/Medline/Antacids%20high.jpg http://www.lifespan.org/adam/graphics/images/en/19235.jpg Effects/Symptoms

8. Simple blood tests can determine if H. Pylori is present Detecting bacterial proteins in the stool. Urea breath test. The urea breath test is based on the ability of H. pylori to break down urea, a chemical made up of nitrogen and carbon. 1st the patient takes a capsule containing urea, the carbon dioxide is absorbed in the lining of the stomach. 2nd it is exerted from the lungs by breathing 3rd samples of the exhaled breath is taken and the carbon dioxide isotope is measure http://www.lpch.org/photos/greystone/ei_2578.gif Endoscopy can be performed. This is when a fiber optic tube is passed though the patients mouth into the stomach lining to perform biopsies. http://www.3dchem.com/imagesofmolecules/Urea.jpg http://www.bmed.com/images/john3.jpg Diagnosis

9. Course of antibiotics to eliminate bacteria Medication to decrease acid production until ulcer heals Drugs can heal but the ulcer can appear again if the H.Pylori bacteria is present and not eliminated Course of antibiotics to eliminate bacteria Medication to decrease acid production until ulcer heals Drugs can heal but the ulcer can appear again if the H.Pylori bacteria is present and not eliminated http://www.gesa.org.au/images/leaflets/GESA-3.jpg Treatment

10. 10% of Americans have ulcers Twice as many men develop ulcers 60% of Americans over 60 have H.Pylori More than 80% of adult Japanese, Latin Americans and Africans are infected 25 million Americans will suffer from an ulcer at some point during their lifetime Half of the world’s population is infected with H.Pylori; most common bacterial infection in humans In developing countries the percent to carry this bug is 80% but only about 30% in America Statistics & Other Information

11. Before H. pylori was identified, many people had peptic ulcers for years. Now, with proper treatment, the outlook for peptic ulcers is excellent. However, people who have had a peptic ulcer should avoid aspirin, NSAIDs and smoking to prevent ulcers from returning. The prognosis for recovery from ulcers is good for most patients. Nearly all ulcers respond to the medications now used to treat them. The rate of recurrence of ulcers can be cut to 5% through the elimination of the Helicobacter pylori bacterium. Researchers are trying to develop a new vaccine. http://www.flu-vaccine.org/images/flu-vaccine.jpg Future Outlook

12. _____(2004). BC Health Guide. May2nd,2008. http://www.bchealthguide.org/kbase/topic/major/hw217846/description.htm Bunch, Bryan(1997). Ulcers. Diseases (Vol. 8 pp. 89-90). United States: Grolier Educational. David B. Jacoby, M.D.(2005). Ulcers. Encyclopedia of Family Health. (Vol. 17, pp, 2313 – 2314). New York: Marshall Cavendish Corporation. David B. Jacoby, M.D.(1998). Stomach. Encyclopedia of Family Health. (Vol. 14, pp. 1895 – 1860). Marshall Cavendish Limited. Griffin P. Rodgers, M.D., M.A.C.P.(2008) NIDDK.May 2nd, 2008.http://digestive.niddk.nih.gov/ddisease/hpylori/ Miskovitz, Paul, M.D., & Betancourt, Marian(2005). The Doctor’s Guide to Gastrointestinal Health. Hoboken, New Jersey: John Wiley & Sons Inc. Railey, Chris.(2007)Peptic Ulcers and Bacterial Infections. May 6th, 2008.http://hmiworld.org/hmi/issues/July_Aug_2007/around_ulcers.html Stephen E. Shaffer, MD.(2006)Kid’s Health, Peptic Ulcers. May 2nd, 2008. http://www.kidshealth.org/parent/medical/digestive/peptic_ulcers.html Reference Page