Peptic ulcer and Helicobacter pylori

Peptic ulcer is a lesion with loss of substance from the gastroduodenal mucosa. Although the incidence of peptic ulcer disease is decreasing, it still affects a large part of the population.

The Helicobacter pylori is found in more than 90% of cases of peptic ulcer. It is a type of bacteria that causes infections in the stomach.

It is found in approximately two thirds of the world's population. It is possible that it is transmitted through contaminated water and food.

Causes of peptic ulcer

Most ulcers are caused by an imbalance between the aggressive and defensive agents of the gastroduodenal mucosa. This imbalance is secondary to infection by Helicobacter pylori or the consumption of non-steroidal anti-inflammatory drugs (NSAIDs).

In cases of peptic ulcer that present Helicobacter, the eradication of the bacteria will reduce recurrences. However, only between 10 and 20% of people infected by Helicobacter pylori will develop at some point a peptic ulcer.

When there is a chronic use of NSAIDs, 50% of these people will present superficial gastric lesions. In addition, ulcers in these cases are usually asymptomatic.

The risk factors for peptic ulcer in people who consume NSAIDS are:

• History of peptic ulcer.
• Age, over 60 years old
• Use of anticoagulants or corticosteroids.
• High doses of NSAIDs.
• Infection by Helicobacter pylori.

Even though smoking seems to negatively influence the healing of peptic ulcer, there are no studies that show that tobacco, stress or diet are factors that trigger peptic ulcer.

Symptoms and diagnosis of peptic ulcer

Most people affected with ulcer present a dyspepsia symptomatology. The pattern of dyspepsia symptoms already guides the diagnosis of ulcer. Symptoms include epigastric pain on an empty stomach that subsides with food or antacids.

For diagnosis it is important to have information about lifestyle, pharmacological treatments and personal history of ulcer or infection by Helicobacter pylori.

In some people, ulcer can coexist with gastroesophageal reflux disease. This can make diagnosis difficult. However, the most sensitive and specific test to confirm the existence of ulcer is upper digestive endoscopy (gastroscopy).

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Treatment

The goal of treatment is to relieve symptoms, the healing of the ulcer and the prevention of complications. In addition, it is recommended to follow hygienic-dietetic measures, such as:

• Avoid the use of NSAIDs.
• Do without food and drinks that cause the symptoms.
• No Smoking, since the tobacco delays the healing of the ulcer and increases the recurrences.

Antisecretory treatment

At present Proton pump inhibitors (PPIs) are the drugs that achieve the highest rates of healing of the mucosa.

They should be taken before meals. In addition, there are studies that show greater effectiveness if they are taken in the morning than at the end of the day.

Proton pump inhibitor drugs They need 3 to 5 days to reach the maximum effect. However, there is a variability in the clinical response due to the hepatic metabolism of the drug.

The duration of peptic ulcer treatment depends on the location of the peptic ulcer. In the duodenal ulcer it is maintained for 4 weeks, while in the gastric it is between 6 and 8 weeks.

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Eradication of Helicobacter pylori

The eradication of the bacteria achieves healing of the ulcer. In addition, ulcerative complications in the long term are also diminished.

The eradication treatment of first choice consists of administering a PPI and antibiotics (clarithromycin, amoxicillin and metronidazole) for at least ten days.

In patients allergic to penicillin, IBP, clarithromycin and metronidazole are used as first choice for at least 10 days.

Recommendations for the use of NSAIDs

When there are risk factors for peptic ulcer, Before taking NSAIDs, it is advisable to take into account the following recommendations:

• Review the indication: if the effect we are looking for is analgesia or lowering fever, it is appropriate to take acetaminophen.
• Always use the minimum effective dose of NSAIDs and, in addition, the least toxic dose.
• Avoid taking joint NSAIDs, anticoagulants and corticosteroids.