Peptic ulcer are among the most common known to man. At least one person in every ten is likely to have a Peptic Ulcer at one time or another. ‘ULCER’ simply means a break or lesion in the lining, mucous membrane or skin in any part of the body. It is possible to get an ulcer almost anywhere. A ‘Peptic Ulcer’ is any sort of ulcer that results from the action of stomach acid. It derives its name from the enzyme pepsin, and it normally occurs in stomach when they are called gastric ulcer or in the duodenum—duodenal Ulcer.
Peptic Ulcer is a non-malignant ulcer occurring in that part of the digestive tract which is exposed to the gastric secretions. Thus it may occur in the lower part of oesophagus, stomach or duodenum and small intestines anatomized to stomach and is therefore called gastric or duodenal ulcer respectively.
It is called ‘Peptic Ulcer’ generally because ‘Pepsin’ plays an important role in the causation of Ulcer.
(1) TYPICAL PRESENTATION—more typical In duodenal ulcer but more confusing and not so typical in gastric ulcer.
(a) Early symptoms—
(i) Flatulence and dyspepsia following meals,
(ii) Vague epigastric distress and fullness.
(iii) Heart burn and burning sensation in the stom¬ach.
(b) Late symptoms—
(i) Steady and gnawing epigastric pain.
(ii) pain having a chronological relationship to eating (Food-comfort-pain).
(2) ATYPICAL PRESENTATIONS—due to complications of peptic ulcer.
(i) Severe and constant pain—when ulcer is deep, penetrating pain may radiate to back or shoulder.
(ii) Nausea and vomiting—when pyloric stenosis is present.
(iii) Haematemesis and melaena—vomiting blood and passing black tarry stool; ensure if patient is not taking iron salts orally.
(iv) Shock-agonising epigastric pain—if perforation of peptic ulcer is present.
(v) Diarrhoea— due to stomach ulcer of Z—E syn¬drome.
1. PAIN—Epigastric or vague abodominal pain is a characteristic and predominant presenting symptom. Careful ex¬amination of its characteristics as given below can greatly help in distinguishing between chronic duodenal and un¬complicated peptic ulcer and between peptic ulcer and other disorders that mimic peptic ulcer.
(i) Duodenal ulcer—well localized in epigastric or sub-xiphoid area.
(ii) Gastric ulcer—epigastric area, often not well localized, even vague discomfort.
(iii) Oesophageal ulcer—substemal or sub-xiphoid area.
(iv) Post bulbar ulcer—lower epigastric or hypo-gastric ulcer.
(b) CHARACTER OF PAIN—Steady for a period of time (usually 30-90 min.) and then disappears. It is variously described as ‘gnawing’, ‘burning’ ‘aching’, ‘hunger pains’, a sense of fullness, ‘gas pain’ etc.
(c) INTENSITY OF PAIN
It is directly proportional to—
(i) site-lowest in duodenal, intermediate in gastric and highest in post bulbar or stomach ulcers.
(ii) size of ulcer,
(iii) Patients sensitivity to pain,
(iv) Serosal involvement—as in penetrating ulcer,
(v) Presence of complications.
(d) RHYTHEMICITY OF PAIN
In duodenal ulcer—onset of pain is about 2 hrs. after meals; often present at night (between midnight 12-2 a.m), but seldom on awakening, i.e., food—comfort (2 hrs.)—pain.
In gastric ulcer—pain appears soon after meals pain seldom present at night and on awakening.
(i) Radiation—pain may radiate to back
(ii) Duration of pain—usually 30-90 min.
(iii) Periodicity—Both duodenal and gastric ulcers show periodicity, i.e., pain occurs for days and months subsides for many months and then recurs to repeat the cycle.
(iv) Relieving factors—
Duodenal ulcer—food (especially milk) and antacids usually bring immediate relief.
Gastric ulcer—food brings little or no relief, but may cause pain sometimes. Pain relieved by antacids.
Duodenal ulcer—patients likes to eat almost any bland diet, specially milk and gains weight.
Gastric ulcer—patient afraid to eat and loses weight.
Localized epigastic tenderness is the only physical findings of some value in uncomplicated peptic ulcer. Other findings present if complications like pyloric stenosis, peptic perforation, haematemesis and melaenas etc. occur.
(b) Radiology—This remains the major diagnostic tool in our country because facilities for endoscopy are hardly available. Barium meal study should be done by a competent radiologist who can employ special techniques and manoeures to demonstrate small ulcer so that more than 80% cases of peptic ulcer can be demonstrated.
(c)Endoscopy—Fibreoptic flexible gastroscopy will detect over 90% lesions including ulcers of distal duodenum, esophagus, stomach ulcers, superficial ulcers, and those near the angulus along the lesser curvature. Ulcers can be directly visualized, photographed and contents scraped for cytological studies with the modern fibreoptic endoscopes fitted with camera. Unfortunately the scope of this valuable diagnostic tool is limited.
High basal secretory activity of 10-30 mEq and a ratio of basal to maximal stimulation secretion .of 0.6 or more is characteristic of Z-E Syndrome.
(e) Gastric biopsy—if malignancy is suspected.
(f)Serum gastric level—if features of Z-E Syndrome present it is ten times more than the normal value.
The following are the important complications:-
2. Haematemesis and melaena.
3. Pyloric obstruction.
4. Recurrent or stomach ulcers.
5. Malignant change—in gastric ulcers.
1.Early warning symptoms.
ulcer symptoms, especially pain, become aggravated and continuous instead of rhythmic.
Fullness after eating.
2.Other Clinical symptoms are—
(a) Vomiting—It is the predominant symptom; a vague aching pain after meals followed by hyperperistalsis and releived by vomiting is the usual feature. The vomitus contains food ingested during the previous 24 hours. Vomiting is usually restricted to not more than 2-3 times daily even in serious obstruction.
PRINCIPLE OF TREATMENT OF UNCOMPLICATED PEPTIC ULCER.
1. Diet adjustments with milk-dominent diet is extremely useful. Milk is a good and cold milk may be very useful in acute stages. Even milk drip via Kyle’s tube may be helpful when pain is not otherwise releived.
2. Avoid spices, fried food, smoking and alcohol completely.
3. Rest definitely helps. It does not mean absolute rest in bed. A restful life with peaceful atmosphere. Possibly a holiday in a quiet peace with proper diet regimen may enhance healing.
1. Argentum nit—Small spot between xyphoidnaval sensitive to pressure; pain radiate in all direc-tions. Gnawing, ulcerative pain is epigastrium. Pain below and to the left of the xyphoid process in a small spot extending to a corresponding point in spine, where pressure aggravates it.Looks as if dying .
2.Hydrastis—Vomits all she eats, expect milk and water mixed. Backache (maybe severe); Tired aching across small of back.Excessive sweat of armpits and genitalia which is offensive. Sinking, gone feeling in stomach and Obstinate constipation.
3.Ignatia—Pain is located in a small circumscribed spot, relief from eating. Pains may appear gradually and subside suddenly; or appear as suddenly as they disappear.
4.Lycopodium—Yellowish-gray color of face. Pit of stomach swollen and sensitive to touch. Aching in stomach in evening and after eating.
5.Arsenic alb—Great prostration and weakness: Restlessness with tossing about. Vomiting is present immediately after eating or drinking and Great burning in the stomach.
6.Carbo veg—Burning in the stomach spreading down to small back and up to the shoulders. Pain paroxys¬mal, takes away the breath. Vomiting of sour bloody masses. Ameliorates from cold drink.
N.B. with the administration of proper homeopathic medicine subsequent magnetic therapy should be done as per therapeutic application of magnets.