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Dyspepsia
(Peptic Ulcer Disease) |
Article Sections
Causes
Symptoms
Diagnosis
Treatment |
Contributed by Singapore General Hospital
Introduction
Dyspepsia refers to the presence of persistent or recurrent pain or discomfort centred in the upper abdomen.
Causes
There are many causes of dyspepsia. Common causes are:
- Peptic ulcer disease
- Non ulcer dyspepsia
- Gallstones
Peptic ulcer disease
This is a defect in the innermost layer of the wall of the stomach or of the duodenum (the section of the small intestine connected to the stomach).
Two common causes of Peptic ulcer disease are:
Helicobacter pylori infection. This is a bacterium which lives in the innermost lining of the stomach. It is thought to be responsible for 90% of all duodenal ulcers and about 60% of stomach ulcers.
Aspirin and other painkillers belonging to the family called non-steroidal anti-inflammatory drugs (NSAID). Nowadays, aspirin are commonly given to sufferers of heart disease and stroke. NSAIDs are commonly used as pain killers.
Symptoms
There may be no symptoms at all and the ulcer may be discovered while investigating another problem, e.g. anaemia ( shortness of red blood cells).
Other patients may present with dyspepsia or commonly associated by most people as 'gastric pain'. This discomfort have been described variously as 'burning, pulling, bloating or sharp' pain. Classically, pain of duodenal ulcer occur before meals and tend to be relieved by food. Sufferers also tend to wake in the middle of the night with pain. Weight loss is uncommon.
When should I request to see a doctor urgently if have gastric pain?
You should see a doctor urgently in the following situations:
- Recent weight loss.
- Persistent vomiting after food. This indicates that there may be area of narrowing obstructing the drainage of food due to the ulcer.
- If you vomit blood or pass out black and soft stool. This means that your ulcer is bleeding.
- Severe, excruciating upper tummy pain suggesting that your ulcer has perforated i.e. burst apart.
Diagnosis
Your doctor can either order a barium meal and gastroscopy ( see related articles on this website) to confirm if you have Peptic Ulcer Disease.
To confirm if you have a Helicobacter pylori infection, noninvasive tests that your doctor can order are a blood test or Urea breath test. Most experts still feel that 'office based, finger prick' blood test for antibody against the bacteria should not be used for screening purposes. Your doctor can also send your blood sample away for testing in the laboratory. This second method is generally regarded as more accurate than the 'office based, finger prick' test. The last noninvasive test is the breath test. This involves drinking some solution containing radioactive carbon which will be released in your breath if the bacteria is present in your stomach. However, all these noninvasive tests do not tell you whether you have got ulcer and there is still an ongoing debate in the medical community whether patients should receive therapy to eradicate the bacteria if they do not have ulcer.
The invasive test is biopsy which your doctor can do during gastroscopy. A small biopsy of stomach lining can be tested for the bacterial enzyme (CLO test ) or examined directly under microscope for the bacteria.
Treatment
If the ulcer is caused by aspirin or NSAID's, your doctor would definitely ask you to stop these drugs and you would be given acid reducing agents ( cimetidine, famotidine, ranitidine, omeprazole, lansoprazole ) which cut acid productions and accelerate ulcer healing process. If your ulcer is related to Helicobacter pylori, your doctor would give triple therapy ( three drugs) to eradicate the bacteria. Generally, triple therapy can eradicate successfully in up to 90% of cases. Triple therapy consists of one acid reducing agents ( generally of the stronger group such as omeprazole or lansoprazole ) and two antibiotics taken for one week. Common sideeffects are nausea, vomiting and diarrhoea which are generally mild. Severe sideeffects are kidney failure and inflammation of the large bowel. Fortunately, severe sideeffects are very uncommon.
Smoking and alcohol have also been shown to impair ulcer healing. These should be stopped if possible. Foods such as chilli, sour foods, coffee do not predispose a person to peptic ulcer disease, nor do they interfere with ulcer healing.
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