Duodenal or Gastric Ulcer and Nonulcer Dyspepsia
From Expert System: Upper Abdominal Symptoms, Pain, Indigestion, or Heartburn
Ulcer disease alone afflicts more than 25 million Americans. Each year, according to the CDC, there are 500,000 to 850,000 new cases of peptic ulcer disease and more than one million ulcer-related hospitalizations. Yet the majority of sufferers treat themselves with over-the-counter antacids and other drugs. Symptoms of ulcer and nonulcer dyspepsia are typically those of gnawing or burning pain in the epigastrium (upper mid abdomen, below the inverted V of the rib cage or "pit of the stomach") (epigastrium), but discomfort may also be felt lower down in the mid abdomen above the navel, or on either side of the epigastrium, more often on the left.
Usually pain comes and goes, can last for minutes to hours, is sometimes seasonal, and frequently occurs between meals or early in the morning when the stomach tends to be empty. Classically there is prompt relief with food or antacids. Some patients, however, especially children, present with more confusing upper abdominal symptoms, or "indigestion" with no clear relation to meals or antacids. In these cases, ulcer symptoms are not typical and include nausea, vomiting, and loss of appetite. It is usually impossible to distinguish clinically between true ulcer (peptic or duodenal and gastric) and NONULCER DYSPEPSIA in which the signs and symptoms of ulcer are present, but no ulcer can be seen on imaging studies, such as barium X-rays (upper GI series) and upper endoscopy. The relationship of ulcer to infection with H. pylori is discussed in one of the links on our diagnosis page.
Ulcer disease if severe, persistent, and untreated can result in complications such as gastric or duodenal bleeding, perforation, or obstruction. Thanks to the availability of a wide variety of drugs, such as H2 receptor antagonists like Zantac©, Tagamet©, pepcid©, Axid©,-and PPI's (proton pump inhibitors) such as Prilosec©, Prevacid©, or Aciphex©, these complications have become much less common over the years. Both gastric and duodenal ulcer are 3-5 times more common, not only in smokers and drinkers, but in patients, especially older people, who take steroids or non-narcotic pain relievers called non-steroidal anti- inflammatory medication (NSAIDS), such as advil, motrin, tylenol, aspirin, ibuprofen, and a host of other drugs.
DIAGNOSIS: Between 12 million and 14 million upper endoscopy procedures are performed in this country each year, overwhelmingly for innocent GI symptoms. This invasive procedure is hardly ever indicated in uncomplicated peptic ulcer. The procedure is so unpleasant, it is carried out almost routinely under "conscious sedation," (sometimes the equivalent of general anesthesia) to prevent a struggling patient from injuring himself. This adds to the risk, with major complications of bleeding, perforation, or cardiopulmonary collapse occurring in 1 of every 1,200-1,500 and DEATH in 1 in 2,000-4,000 procedures! (Always read your informed consent form before signing it.)
Reasonable indications for upper endoscopy include retrieval of a foreign body, bleeding, or in those rare instances when ominous findings appear on X-rays of the esophagus or stomach. The chance of missing a stomach cancer in patients having a normal GI series and without a suspicious history is virtually nil.
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