Clinical Manifestations Diagnosis and Treatment

The classic symptom of ulcer is dyspepsia, a burning epigastric pain usually occurring 2-3 h after meals and at night (between 11.00 p.m. and 2.00 a.m.) when acid secretion is maximal. Relief often occurs with ingestion of food and alkali. Although suggestive of peptic ulcer, dyspepsia is not a sensitive or specific measure of peptic ulcer. Only about 50% of DU patients have the typical symptom of dyspepsia. Some ulcer patients develop a stomach that is easily irritated by food, mechanical distention, or other chemical stimuli.

The sensitivity of radiography for the diagnosis of ulcers ranges from 50 to 90%, depending on the technical skill of the radiographer and the size and location of the ulcer. Fiberoptic endoscopy is a sensitive, specific, and safe method for diagnosing peptic ulcers. It gives the advantage of direct visualization and access to tissue for biopsy.

Data from placebo-controlled trials show that untreated peptic ulcers can heal within 4 weeks in 30% of GU and 40% of DU patients. Recurrence usually occurs in two-thirds of patients who have documented ulcer healing. Complications of ulcers might include hemorrhage, obstruction, and perforation. Treatment involves drugs that reduce acid output such as histamine-2 (H2) receptor antagonists, proton pump inhibitors, antacids, and antibiotics to treat H. pylori infection. In the case of NSAID-induced ulcers, treatment is targeted at reducing acid output and the cessation of NSAIDs, if possible. Surgery is reserved for those with complicated ulcer disease.

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