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Peptic ulcer
Classification and external resources
Deep gastric ulcer
ICD-10 K25.-K27.
ICD-9 531-534
DiseasesDB 9819
eMedicine med/1776  ped/2341
MeSH D010437
A benign gastric ulcer (from the antrum) of a gastrectomy specimen.
A benign gastric ulcer (from the antrum) of a gastrectomy specimen. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The International Statistical Classification of Diseases and Related Health Problems 10th Revision ( ICD -10) is a coding of diseases and signs symptoms abnormal findings K00-K93 - Diseases of the digestive system (K00-K14 Diseases of oral cavity salivary glands and jaws ( Disorders of Tooth development and Eruption K00-K93 - Diseases of the digestive system (K00-K14 Diseases of oral cavity salivary glands and jaws ( Disorders of Tooth development and Eruption The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. The Diseases Database is a free Website that provides information about the relationships between medical conditions Symptoms, and Medications. eMedicine is an online clinical medical knowledge base that was founded in 1996 by Scott Plantz and Richard Lavely two medical doctors Medical Subject Headings ( MeSH) is a huge Controlled vocabulary (or metadata system for the purpose of indexing journal articles and books A gastrectomy is a partial or full surgical removal of the Stomach.

A peptic ulcer, also known as PUD or peptic ulcer disease[1], is an ulcer (defined as mucosal erosions equal to or greater than 0. Ulcers are healing wounds that develop on the skin mucous membranes or eye 5 cm) of an area of the gastrointestinal tract that is usually acidic and thus extremely painful. As much as 80% of ulcers are associated with Helicobacter pylori, a spiral-shaped bacterium that lives in the acidic environment of the stomach, however only 20% of those cases go to a doctor. Helicobacter pylori ( is a Gram-negative, microaerophilic Bacterium that inhabits various areas of the stomach and Duodenum. Ulcers can also be caused or worsened by drugs such as Aspirin and other NSAIDs. Aspirin, or acetylsalicylic acid (ASA (əˌsɛtɨlsælɨˌsɪlɨk ˈæsɨd is a Salicylate drug, often used as an Analgesic to relieve Non-steroidal anti-inflammatory drugs, usually abbreviated to NSAID s or NAID s, are drugs with Analgesic, Antipyretic and in higher Contrary to general belief, more peptic ulcers arise in the duodenum (first part of the small intestine, just after the stomach) than in the stomach. In Anatomy of the Digestive system, the duodenum is a hollow jointed tube about 25-30 cm (10-12 in long connecting the Stomach to the Jejunum In Biology the small Intestine is the part of the Gastrointestinal tract (gut between the Stomach and the Large intestine, and comprises In Human anatomy, the stomach is a J-shaped hollow muscular organ of the Gastrointestinal tract involved in the second phase of Digestion, following About 4% of stomach ulcers are caused by a malignant tumor, so multiple biopsies are needed to make sure. Malignant (from the Latin roots mal- = "bad" and -genus = "born" is a medical term used to describe a severe and progressively worsening disease Duodenal ulcers are generally benign.

Contents

Classification

A peptic ulcer may arise at various locations:

Signs and symptoms

Symptoms of a peptic ulcer can be:

A history of heartburn, gastroesophageal reflux disease (GERD) and use of certain forms of medication can raise the suspicion for peptic ulcer. Heartburn or pyrosis is a painful or burning sensation in the Esophagus, just below the breastbone usually associated with regurgitation of gastric acid Gastroesophageal reflux disease ( American English and Canadian English) or Gastro-oesophageal reflux disease ( British English, Hiberno-English Medicines associated with peptic ulcer include NSAID (non-steroid anti-inflammatory drugs) that inhibit cyclooxygenase, and most glucocorticoids (e. Non-steroidal anti-inflammatory drugs, usually abbreviated to NSAID s or NAID s, are drugs with Analgesic, Antipyretic and in higher Glucocorticoids (GC are a class of Steroid hormones characterised by an ability to bind with the glucocorticoid receptor ( GR) and trigger similar effects g. dexamethasone and prednisolone). Dexamethasone is a potent synthetic member of the glucocorticoid class of Steroid Hormones It acts as an Anti-inflammatory and immunosuppressant Prednisolone is the active metabolite of Prednisone. Uses It is a Corticosteroid drug with predominantly Glucocorticoid and low Mineralocorticoid

In patients over 45 with more than 2 weeks of the above symptoms, the odds for peptic ulceration are high enough to warrant rapid investigation by EGD (see below).

The timing of the symptoms in relation to the meal may differentiate between gastric and duodenal ulcers: 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. Gastric acid is one of the main Secretions of the Stomach, together with several Enzymes and Intrinsic factor. In Human anatomy, the stomach is a J-shaped hollow muscular organ of the Gastrointestinal tract involved in the second phase of Digestion, following Symptoms of duodenal ulcers would manifest mostly before the meal — when acid (production stimulated by hunger) is passed into the duodenum. In Anatomy of the Digestive system, the duodenum is a hollow jointed tube about 25-30 cm (10-12 in long connecting the Stomach to the Jejunum However, this is not a reliable sign in clinical practice.

Complications

Pathophysiology

Tobacco smoking, not eating properly, blood group, spices and other factors that were suspected to cause ulcers until late in the 20th century, are actually of relatively minor importance in the development of peptic ulcers. Tobacco Smoking is the inhalation of smoke from burned dried or cured leaves of the Tobacco plant most often in the form of a Cigarette. A blood type (also called a blood group) is a classification of Blood based on the presence or absence of inherited Antigenic substances on the A spice is a dried Seed, Fruit, Root, Bark or vegetative substance used in Nutritionally insignificant quantities as a Food additive [4]

A major causative factor (60% of gastric and up to 90% of duodenal ulcers) is chronic inflammation due to Helicobacter pylori that colonizes (i. Inflammation ( Latin, inflamatio, to set on fire is the complex biological response of vascular tissues to harmful stimuli such as Pathogens Helicobacter pylori ( is a Gram-negative, microaerophilic Bacterium that inhabits various areas of the stomach and Duodenum. e. settles there after entering the body) the antral mucosa. Pyloric antrum ( antrum, lesser cul-de-sac) is the initial portion of the pyloric part of the Stomach. The mucous membranes (or mucosae; singular mucosa) are linings of mostly endodermal origin covered in Epithelium, which are involved in The immune system is unable to clear the infection, despite the appearance of antibodies. Thus, the bacterium can cause a chronic active gastritis (type B gastritis), resulting in a defect in the regulation of gastrin production by that part of the stomach, and gastrin secretion can either be decreased (most cases) resulting in hypo- or achlorhydria or increased. The Bacteria ( singular: bacterium) are a large group of unicellular Microorganisms Typically a few Micrometres in length bacteria have Gastritis is an inflammation of the lining of the stomach There are many possible causes In humans gastrin is a Hormone that stimulates secretion of Gastric acid (HCl by the Parietal cells of the Stomach, as well as aiding in Achlorhydria and hypochlorhydria refer to states where the production of Gastric acid in the Stomach is absent or low respectively Gastrin stimulates the production of gastric acid by parietal cell and, in H. In humans gastrin is a Hormone that stimulates secretion of Gastric acid (HCl by the Parietal cells of the Stomach, as well as aiding in Gastric acid is one of the main Secretions of the Stomach, together with several Enzymes and Intrinsic factor. pylori colonization responses that increase gastrin, the increase in acid can contribute to the erosion of the mucosa and therefore ulcer formation. The mucous membranes (or mucosae; singular mucosa) are linings of mostly endodermal origin covered in Epithelium, which are involved in Studies [5] have shown eating cabbage or cabbage juice can increase the mucosa lining in the stomach.

Another major cause is the use of NSAIDs (see above). Non-steroidal anti-inflammatory drugs, usually abbreviated to NSAID s or NAID s, are drugs with Analgesic, Antipyretic and in higher The gastric mucosa protects itself from gastric acid with a layer of mucus, the secretion of which is stimulated by certain prostaglandins. Gastric acid is one of the main Secretions of the Stomach, together with several Enzymes and Intrinsic factor. NSAIDs block the function of cyclooxygenase 1 (cox-1), which is essential for the production of these prostaglandins. Newer NSAIDs (celecoxib, rofecoxib) only inhibit cox-2, which is less essential in the gastric mucosa, and roughly halve the risk of NSAID-related gastric ulceration. Celecoxib ( INN) (sɛlɨˈkɒksɪb is a Non-steroidal anti-inflammatory drug (NSAID used in the treatment of Osteoarthritis, Rheumatoid arthritis Rofecoxib (Rofecoxib is a nonsteroidal anti-inflammatory drug ( NSAID) marketed by Merck & Co As the prevalence of H. pylori-caused ulceration declines in the Western world due to increased medical treatment, a greater proportion of ulcers will be due to increasing NSAID use among individuals with pain syndromes as well as the growth of aging populations that develop arthritis.

Glucocorticoids lead to atrophy of all epithelial tissues. Glucocorticoids (GC are a class of Steroid hormones characterised by an ability to bind with the glucocorticoid receptor ( GR) and trigger similar effects In biology and medicine epithelium is a tissue composed of cells that line the cavities and surfaces of structures throughout the body Their role in ulcerogenesis is relatively small.

There is debate as to whether Stress in the psychological sense can influence the development of peptic ulcers (see Stress and ulcers). A peptic ulcer, also known as PUD or peptic ulcer disease, is an Ulcer (defined as mucosal erosions equal to or greater than 0 Burns and head trauma, however, can lead to "stress ulcers", and it is reported in many patients who are on mechanical ventilation. A burn is a type of Injury that may be caused by Heat, cold, Electricity, Chemicals, Light, Radiation, or Traumatic brain injury. THIS PAGE IS FOR INFORMATION ON HEAD INJURY (NOT SPECIFICALLY THE BRAIN--> Head injury is In Medicine, mechanical ventilation is a method to mechanically assist or replace spontaneous breathing when patients cannot do so on their own

Smoking leads to atherosclerosis and vascular spasms, causing vascular insufficiency and promoting the development of ulcers through ischemia. Tobacco Smoking is the inhalation of smoke from burned dried or cured leaves of the Tobacco plant most often in the form of a Cigarette. Atherosclerosis is a Disease affecting arterial Blood vessels It is a chronic inflammatory response in the walls of arteries in large part due to the accumulation In Medicine, ischemia ( Greek ισχαιμία, isch- is restriction hema or haema is Blood) is a restriction

Overuse of laxatives is also known to cause peptic ulcers.

A family history is often present in duodenal ulcers, especially when blood group O is also present. In Medicine, a family history consists of information about disorders that a patient's direct blood relatives have suffered from Inheritance appears to be unimportant in gastric ulcers.

Gastrinomas (Zollinger Ellison syndrome), rare gastrin-secreting tumors, cause multiple and difficult to heal ulcers. A gastrinoma is a Tumor that secretes Gastrin. It is frequently the source of the gastrin in Zollinger-Ellison syndrome. Zollinger-Ellison syndrome is a disorder where increased levels of the hormone Gastrin are produced causing the Stomach to produce excess Hydrochloric acid

Stress and ulcers

Despite the finding that a bacterial infection is the cause of ulcers in 80% of cases, bacterial infection does not appear to explain all ulcers and researchers continue to look at stress as a possible cause, or at least a complication in the development of ulcers. An infection is the detrimental Colonization of a host Organism by a foreign Species. An infection is the detrimental Colonization of a host Organism by a foreign Species.

An expert panel convened by the Academy of Behavioral Medicine research concluded that ulcers are not purely an infectious disease and that psychological factors do play a significant role. An infectious disease is a clinically evident Disease resulting from the presence of Pathogenic microbial agents including Pathogenic viruses Pathogenic [1] Researchers are examining how stress might promote H. pylori infection. For example, Helicobacter pylori thrives in an acidic environment, and stress has been demonstrated to cause the production of excess stomach acid.

The discovery that Helicobacter pylori is a cause of peptic ulcer has tempted many to conclude that psychological factors are unimportant. But this is dichotomised thinking. There is solid evidence that psychological stress triggers many ulcers and impairs response to treatment, while helicobacter is inadequate as a monocausal explanation as most infected people do not develop ulcers. Psychological stress probably functions most often as a cofactor with H pylori. It may act by stimulating the production of gastric acid or by promoting behavior that causes a risk to health. Gastric acid is one of the main Secretions of the Stomach, together with several Enzymes and Intrinsic factor. Unravelling the aetiology of peptic ulcer will make an important contribution to the biopsychosocial model of disease. The biopsychosocial model is a general model or approach [6]

A study of peptic ulcer patients in a Thai hospital showed that chronic stress was strongly associated with an increased risk of peptic ulcer, and a combination of chronic stress and irregular mealtimes was a significant risk factor (PMID 12948263).

A study on mice showed that both long-term water-immersion-restraint stress and H. pylori infection were independently associated with the development of peptic ulcers (PMID 12465722).

Differential diagnosis of epigastric pain

Diagnosis

An esophagogastroduodenoscopy (EGD), a form of endoscopy, also known as a gastroscopy, is carried out on patients in whom a peptic ulcer is suspected. Gastritis is an inflammation of the lining of the stomach There are many possible causes Stomach or gastric cancer can develop in any part of the Stomach and may spread throughout the stomach and to other organs particularly the Esophagus and Pancreatitis is the Inflammation of the Pancreas. See also Acute pancreatitis and Chronic pancreatitis for more details Cholecystitis is Inflammation of the Gall bladder. Causes and pathology Cholecystitis is often caused by Cholelithiasis (the presence of Biliary colic is pain associated with irritation of the viscera secondary to cholecystitis and gallstones Myocardial infarction ( MI or AMI for acute myocardial infarction) also known as a heart attack, occurs when the blood supply Pleurisy, also known as pleuritis, is an Inflammation of the pleura the lining of the Pleural cavity surrounding the Lungs Pleurisy has a variety Pericarditis is an Inflammation ( -itis) of the Pericardium (the fibrous sac surrounding the heart Endoscopy means looking inside and typically refers to looking inside the body for medical reasons using an instrument called an endoscope. By direct visual identification, the location and severity of an ulcer can be described. Moreover, if no ulcer is present, EGD can often provide an alternative diagnosis.

The diagnosis of Helicobacter pylori can be made by:

The possibility of other causes of ulcers, notably malignancy (gastric cancer) needs to be kept in mind. Cancer (medical term Malignant Neoplasm) is a class of Diseases in which a group of cells display uncontrolled Stomach or gastric cancer can develop in any part of the Stomach and may spread throughout the stomach and to other organs particularly the Esophagus and This is especially true in ulcers of the greater (large) curvature of the stomach; most are also a consequence of chronic H. In Human anatomy, the stomach is a J-shaped hollow muscular organ of the Gastrointestinal tract involved in the second phase of Digestion, following pylori infection.

If a peptic ulcer perforates, air will leak from the inside of the gastrointestinal tract (which always contains some air) to the peritoneal cavity (which normally never contains air). This leads to "free gas" within the peritoneal cavity. If the patient stands erect, as when having a chest X-ray, the gas will float to a position underneath the diaphragm. Therefore, gas in the peritoneal cavity, shown on an erect chest X-ray or supine lateral abdominal X-ray, is an omen of perforated peptic ulcer disease.

Macroscopical appearance

Gastric ulcers are most often localized on the lesser curvature of the stomach. The ulcer is a round to oval parietal defect ("hole"), 2 to 4 cm diameter, with a smooth base and perpendicular borders. These borders are not elevated or irregular in the acute form of peptic ulcer, regular but with elevated borders and inflammatory surrounding in the chronic form. In the ulcerative form of gastric cancer the borders are irregular. Surrounding mucosa may present radial folds, as a consequence of the parietal scarring.

Microscopical appearance

A gastric peptic ulcer is a mucosal defect which penetrates the muscularis mucosae and muscularis propria, produced by acid-pepsin aggression. The lamina muscularis mucosae (or "muscularis mucosa" is the thin layer of Smooth muscle found in most parts of the Gastrointestinal tract, located Ulcer margins are perpendicular and present chronic gastritis. During the active phase, the base of the ulcer shows 4 zones: inflammatory exudate, fibrinoid necrosis, granulation tissue and fibrous tissue. The fibrous base of the ulcer may contain vessels with thickened wall or with thrombosis. [7]

Treatment

Younger patients with ulcer-like symptoms are often treated with antacids or H2 antagonists before EGD is undertaken. An antacid is any substance generally a base or Basic salt, which counteracts stomach acidity. The H2-receptor antagonists (H2RA often shortened to H2 antagonist) are a class of drugs used to block the action of Histamine Bismuth compounds may actually reduce or even clear organisms. Bismuth subsalicylate, with a chemical formula C7H5BiO4 is a drug used to treat Nausea, Heartburn, Indigestion,

Patients who are taking nonsteroidal anti-inflammatories (NSAIDs) may also be prescribed a prostaglandin analogue (Misoprostol) in order to help prevent peptic ulcers, which may be a side-effect of the NSAIDs. Non-steroidal anti-inflammatory drugs, usually abbreviated to NSAID s or NAID s, are drugs with Analgesic, Antipyretic and in higher A prostaglandin is any member of a group of Lipid compounds that are derived enzymatically from Fatty acids and have important functions in the Animal body For other uses see Analog (disambiguation. In Chemistry, analogs or analogues are compounds in which one or Misoprostol is a drug that is FDA -approved in the United States for the prevention of non-steroidal anti-inflammatory drug ( NSAID)-induced Side Effect were an influential Disco band that recorded between 1972 and 1995

When H. pylori infection is present, the most effective treatments are combinations of 2 antibiotics (e. g. Clarithromycin, Amoxicillin, Tetracycline, Metronidazole) and 1 proton pump inhibitor (PPI), sometimes together with a bismuth compound. Clarithromycin is a Macrolide Antibiotic used to treat Pharyngitis, Tonsillitis, acute maxillary Sinusitis, acute bacterial exacerbation Amoxicillin ( INN) or amoxycillin ( BAN) is a moderate-spectrum bacteriolytic β-lactam antibiotic used to treat Bacterial Infections This article deals with the specific antibiotic called tetracycline Metronidazole ( INN) (mɛtrəˈnaɪdəzoʊl is a Nitroimidazole anti-infective medication used mainly in the treatment of infections caused by susceptible Proton pump inhibitors (or "PPI"s are a group of drugs whose main action is pronounced and long-lasting reduction of Gastric acid production In complicated, treatment-resistant cases, 3 antibiotics (e. g. amoxicillin + clarithromycin + metronidazole) may be used together with a PPI and sometimes with bismuth compound. An effective first-line therapy for uncomplicated cases would be Amoxicillin + Metronidazole + Rabeprazole (a PPI). Amoxicillin ( INN) or amoxycillin ( BAN) is a moderate-spectrum bacteriolytic β-lactam antibiotic used to treat Bacterial Infections Metronidazole ( INN) (mɛtrəˈnaɪdəzoʊl is a Nitroimidazole anti-infective medication used mainly in the treatment of infections caused by susceptible Rabeprazole is an antiulcer drug in the class of Proton pump inhibitors It was developed by Eisai Co In the absence of H. pylori, long-term higher dose PPIs are often used.

Treatment of H. pylori usually leads to clearing of infection, relief of symptoms and eventual healing of ulcers. Recurrence of infection can occur and retreatment may be required, if necessary with other antibiotics. Since the widespread use of PPI's in the 1990s, surgical procedures (like "highly selective vagotomy") for uncomplicated peptic ulcers became obsolete. The 1990s collectively refers to the years between and including 1990 and 1999 A vagotomy is a surgical procedure that is performed only in humans

Perforated peptic ulcer is a surgical emergency and requires surgical repair of the perforation. Most bleeding ulcers require endoscopy urgently to stop bleeding with cautery or injection.

Epidemiology

In Western countries the prevalence of Helicobacter pylori infections roughly matches age (i. e. , 20% at age 20, 30% at age 30, 80% at age 80 etc). Prevalence is higher in third world countries. Transmission is by food, contaminated groundwater, and through human saliva (such as from kissing or sharing food utensils. )

According to Mayo Clinic, however, there is no evidence that the infection can be transmitted by kissing.

A minority of cases of Helicobacter infection will eventually lead to an ulcer and a larger proportion of people will get non-specific discomfort, abdominal pain or gastritis.

History

See also: Timeline of peptic ulcer disease and Helicobacter pylori

John Lykoudis, a general practitioner in Greece, treated patients for peptic ulcer disease with antibiotics, beginning in 1958, long before it was commonly recognized that bacteria were a dominant cause for the disease. Wikipedia talkFeatured lists for an explanation of this and other inclusion tags below -->This is a timeline of the events relating to the discovery that peptic John Lykoudis (born 1910 in Missolonghi, died 1980 was a General practitioner in Greece who treated patients from Peptic ulcer disease with A general practitioner, or GP is a medical practitioner who provides Primary care and specializes in Family medicine. Greece (Ελλάδα transliterated: Elláda, historically, Ellás,) officially the Hellenic Republic (Ελληνική Δημοκρατία A peptic ulcer, also known as PUD or peptic ulcer disease, is an Ulcer (defined as mucosal erosions equal to or greater than 0 In modern usage an antibiotic is a Chemotherapeutic agent with activity against Microorganisms such as Bacteria, fungi or Protozoa The Bacteria ( singular: bacterium) are a large group of unicellular Microorganisms Typically a few Micrometres in length bacteria have [8]

Helicobacter pylori was rediscovered in 1982 by two Australian scientists, J. Robin Warren and Barry J. Marshall as a causative factor for ulcers. Helicobacter pylori ( is a Gram-negative, microaerophilic Bacterium that inhabits various areas of the stomach and Duodenum. For a topic outline on this subject see List of basic Australia topics. Dr John Robin Warren AC (born 11 June[[ 937]] in Adelaide) is an Australian Pathologist and researcher who is credited with the 1979 Barry James Marshall, AC FRS FAA (born 30 September 1951) is an Australian Physician, Nobel Prize [9] In their original paper, Warren and Marshall contended that most stomach ulcers and gastritis were caused by colonization with this bacterium, not by stress or spicy food as had been assumed before. A spice is a dried Seed, Fruit, Root, Bark or vegetative substance used in Nutritionally insignificant quantities as a Food additive [10]

The H. pylori hypothesis was poorly received, so in an act of self-experimentation Marshall drank a Petri dish containing a culture of organisms extracted from a patient and soon developed gastritis. Helicobacter pylori ( is a Gram-negative, microaerophilic Bacterium that inhabits various areas of the stomach and Duodenum. A Petri dish is a shallow Glass or Plastic Cylindrical lidded dish that biologists use to culture cells It was named after His symptoms disappeared after two weeks, but he took antibiotics to kill the remaining bacteria at the urging of his wife, since halitosis is one of the symptoms of infection. Halitosis, oral malodor, breath odor mouth odor foul breath fetor oris fetor ex ore or most commonly bad breath are terms used to describe noticeably unpleasant [11] This experiment was published in 1984 in the Australian Medical Journal and is among the most cited articles from the journal.

In 1997, the Centers for Disease Control and Prevention, with other government agencies, academic institutions, and industry, launched a national education campaign to inform health care providers and consumers about the link between H. pylori and ulcers. The Centers for Disease Control and Prevention (or CDC) is an agency of the United States Department of Health and Human Services based in unincorporated Helicobacter pylori ( is a Gram-negative, microaerophilic Bacterium that inhabits various areas of the stomach and Duodenum. This campaign reinforced the news that ulcers are a curable infection, and that health can be greatly improved and money saved by disseminating information about H. pylori. [12]

In 2005, the Karolinska Institute in Stockholm awarded the Nobel Prize in Physiology or Medicine to Dr. Karolinska Institutet (often translated from Swedish into English as the Karolinska Institute, and in older texts often as the Royal Caroline The Nobel Prize in Physiology or Medicine (Nobelpriset i fysiologi eller medicin is awarded once a year by the Swedish Karolinska Institute. Marshall and his long-time collaborator Dr. Warren "for their discovery of the bacterium Helicobacter pylori and its role in gastritis and peptic ulcer disease". Gastritis is an inflammation of the lining of the stomach There are many possible causes Professor Marshall continues research related to H. pylori and runs a molecular biology lab at UWA in Perth, Western Australia. The University of Western Australia (UWA is the oldest university in the state of Western Australia.

It was a previously widley accepted misunderstanding that the use of chewing gum resulted in gastric ulcers. The medical profession believed that this was because the action of masticating on gum caused the over-stimulation of the production of hydrochloric acid in the stomach. The high pH (pH 2) was then believed to cause erosion of the stomach lining in the absence of food, thus causing the development of the gastric ulers. This wide acceptance is shown in Medicine for Nurses (Toohey, 1974) which states that hyperchlorhydria was suspected to cause peptic ulcers. In fact, more recently, the New England Journal of Medicine has found a natural tree resin extract, mastic gum, which actively eliminates the H. pylori bacteria. [13]

References

  1. ^ a b GI Consult: Perforated Peptic Ulcer. Retrieved on 2007-08-26. Year 2007 ( MMVII) was a Common year starting on Monday of the Gregorian calendar in the 21st century. Events 1071 - Battle of Manzikert: The Seljuk Turks defeat the Byzantine Army at Manzikert.
  2. ^ Cullen DJ, Hawkey GM, Greenwood DC, et al (1997). "Peptic ulcer bleeding in the elderly: relative roles of Helicobacter pylori and non-steroidal anti-inflammatory drugs". Gut 41 (4): 459–62. PMID 9391242.  
  3. ^ Peptic Ulcer: Peptic Disorders: Merck Manual Home Edition. Retrieved on 2007-10-10. Year 2007 ( MMVII) was a Common year starting on Monday of the Gregorian calendar in the 21st century. Events 680 - Battle of Karbala: Shia Imam Husayn bin Ali, the grandson of the Prophet Muhammad, is decapitated
  4. ^ For nearly 100 years, scientists and doctors thought that ulcers were caused by stress, spicy food, and alcohol. Treatment involved bed rest and a bland diet. Bed rest is a Doctor's prescription to spend a longer period of time in bed Later, researchers added stomach acid to the list of causes and began treating ulcers with antacids. National Digestive Diseases Information Clearinghouse
  5. ^ Cheney G. Rapid (1949). "Healing of peptic ulcers in patients receiving fresh cabbage juice". Cal Med 70 (10).  [1]
  6. ^ Stress and peptic ulcer: life beyond helicobacter. Retrieved on 2007-08-26. Year 2007 ( MMVII) was a Common year starting on Monday of the Gregorian calendar in the 21st century. Events 1071 - Battle of Manzikert: The Seljuk Turks defeat the Byzantine Army at Manzikert.
  7. ^ ATLAS OF PATHOLOGY. Retrieved on 2007-08-26. Year 2007 ( MMVII) was a Common year starting on Monday of the Gregorian calendar in the 21st century. Events 1071 - Battle of Manzikert: The Seljuk Turks defeat the Byzantine Army at Manzikert.
  8. ^ Marshall B. J. , ed. (2002), "Helicobacter Pioneers: Firsthand accounts from the scientists who discovered helicobacters, 1892-1982", ISBN 0-86793-035-7. Basil Rigas, Efstathios D. Papavasassiliou. John Lykoudis. The general practitioner in Greece who in 1958 discovered the etiology of, and a treatment for, peptic ulcer disease.
  9. ^ Marshall B. J. (1983). "Unidentified curved bacillus on gastric epithelium in active chronic gastritis". Lancet 1 (8336): 1273–1275. This article is about the journal For other uses of the term "lancet" see Lancet (disambiguation. PMID 6134060.  
  10. ^ Marshall B. J. , Warren J. R. (1984). "Unidentified curved bacilli in the stomach patients with gastritis and peptic ulceration". Lancet 1 (8390): 1311–1315. PMID 6145023.  
  11. ^ Research Enterprise, The 2005 Nobel Prize in Physiology or Medicine. Retrieved on 2007-08-26. Year 2007 ( MMVII) was a Common year starting on Monday of the Gregorian calendar in the 21st century. Events 1071 - Battle of Manzikert: The Seljuk Turks defeat the Byzantine Army at Manzikert.
  12. ^ Ulcer, Diagnosis and Treatment - CDC Bacterial, Mycotic Diseases
  13. ^ Chewing gum may help ulcer relief. Retrieved on 2001-02-28. Year 2001 ( MMI) was a Common year starting on Monday according to the Gregorian calendar. Events 202 BC - coronation ceremony of Liu Bang as Emperor Gaozu of Han takes place initiating four centuries of the Han Dynasty 's rule

External links

Dictionary

peptic ulcer

-noun

  1. (pathology) An ulcer of an area of the gastrointestinal tract.
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