Talk:Peptic ulcer disease

Plain English
Can we get some accessible, plain language on this page for the layperson please? I'm interested in learning about stomach ulcers but am overwhelmed by all the specific medical terminology. — Preceding unsigned comment added by 203.41.217.162 (talk) 00:55, 5 December 2011 (UTC)

H. pylori pH
In the section regarding stress and the pathophyHIHIHIHsiology of ulcers, there is a sentence asserting that H. pylori thrive in an acidic environment. This is contrary to other reliable sources in the article on H. pylori itself, and in fact the citation for this claim does not seem to substantiate it (I only have access to the abstract). In describing the development of gastric ulcer in patients with high levels of gastric acidity, the H. pylori article indicates that the bacteria colonize the pylorus because it is more alkaline than the corpus of the stomach. The citation for this is even more clear; under Gastric Helicobacter species: [quote]Urease is thought to allow short-term survival in the highly acidic gastric lumen, whereas motility is thought to allow rapid movement toward the more neutral pH of the gastric mucosa; this may explain why both factors are prerequisites for colonization of the gastric mucosa (450, 550, 551). Upon entry, gastric Helicobacter species display urea- and bicarbonate-mediated chemotactic motility toward the mucus layer (710). The spiral morphology and flagellar motility then assist in penetration into the viscous mucus layer, where the more pH-neutral conditions allow growth of the gastric Helicobacter species.[/quote]

I have not edited the article itself because I don't know how to do so without disrupting the entire section. If somebody experienced in editing could address what appears to be a patent error in this article, I would greatly appreciate it. 16:54, 27 July 2011 (UTC)Petakia — Preceding unsigned comment added by 99.6.3.205 (talk)

Anti-acid
Anti-acid treatments such as Zanitidine...


 * Shouldn't this be Ranitidine instead? (Fhimpe 15:30 2 Jun 2003 (UTC))


 * Maybe it should also be noted that doctors will not always choose antacids as this reduces the amount of acid in the stomach which reduces the stomach's ability to protect itself and the body from bacteria, viruses, parasites etc. Many complications can arise from a lack of the protective acidic environment in the stomach including pneumonia, parasitic infections, H. Pylori2 infections etc.  —Preceding unsigned comment added by 61.68.50.65 (talk) 13:56, 18 July 2008 (UTC)


 * Also Ranitidine, although I suppose "anti-acid" should not be confused for an antacid - ranitidine is an H2 receptor antagonist. PGRandom (talk) 23:08, 24 February 2014 (UTC)

Good job. One thing: I'm pretty sure there's blood antibody test for H.pylori. The antibody test shows exposure to H.pylori, not current infection. So, if it's positive and the individual has never been treated for H.pylori, they are given treatment. If the individual has already been treated, there's no point in measuring the antibody, since it may be positive forever. Ksheka 20:48, Apr 28, 2004 (UTC)


 * You're right, I forgot to stick that in (I'll do it later if I've got a chance). There's probably exceedingly little point in measuring anti-HP IgM in a chronic infection! TMN (to my knowledge) it's still controversial to treat HP "blind" without biopsy, but I've seen it happen.   JFW |  T@lk  07:55, 29 Apr 2004 (UTC)
 * Wouldn't the levels of antibody be an idicator whether there is a current infection? Kadhumia flo (talk) 21:39, 1 June 2010 (UTC)

Also, plesae check out the American College of Gastroenterology website, and click on peptic ulcer disease and the abstract that is associated with it. May be useful? I'm not sure... Ksheka 10:16, Apr 29, 2004 (UTC)

edit
Old intro said:


 * By far most instances are now known to be due to Helicobacter pylori, a spiral-shaped bacterium that lives in the acid environment of the stomach.

This wording was not really true, as the linked article states, ~70% of H. pylori infections are asymptomatic, and ~2/3 of world population is infected. So while H. pylori is only one causative factor, in most case requiring some other factors (whether genetic or environmental) to trigger ulceration. NTK 23:27, 30 January 2006 (UTC)

spirochaete
Is H. pylori actually a spirochaete or just a different sort of spiral bacteria? I don't think it is, but this article says it is...

Pathophysiology
"A large array of strange things"? Anyone with medical knowledge, do repharse.

Stress and ulcers
I have heard the issue described in black and white terms:
 * Ulcers are caused by stress alone, i.e., no physical cause whatsoever
 * Ulcers are caused by Helicobacter pylori, i.e., stress is not a factor in the slightest

Isn't it somewhere in the middle of these extremes? --Wing Nut 19:01, 5 July 2006 (UTC)

I've removed a portion of the first sentence in the Stress & Ulcers section then joined the two sentences to remove the original author's 'implicit feeling of discontent for all other explanatory frameworks' from that section. The paragraph is more neutral now. Ralfa 16:45, 27 June 2007 (UTC)

I moved the 'stress and ulcers; section to below the pathophysiology section - H. pylori is the most accepted explanation for stomach ulcers, and from my understanding most other risk factors are either risk factors for H. pylori infection, or only act to increase the likelyhood of ulcers from a pre-existing infection. Hence i feel it flows better presenting 'main theory' before 'additional factors' or if you like 'alternative theories'. May bother reading some articles when i have more time and balancing stuff a little. 124.169.147.21 00:40, 11 November 2007 (UTC)

I must call into question the use of the citation number one (#cite_note-medmag-0). I checked out the source and found nothing related to stress and mentioned expert panel. The citation is an old one so maybe the page changed. — Preceding unsigned comment added by Denarced (talk • contribs) 17:11, 24 May 2011 (UTC)

H Pylori in the duodenum
It is possible for a CLO test to be negative yet to have positive urease breath test results. It seems helicobacter can colonise the duodenum and be the cause for so-called "idiopathic" duodenal ulcers: JFW |  T@lk  08:58, 6 January 2008 (UTC)

Preventative Treatment
What can be done to subside the ulcer naturally? —Preceding unsigned comment added by Mary Jewel (talk • contribs) 16:25, 2 February 2008 (UTC)

Plagiarism
I removed a paragraph in the 'Stress and Ulcers' section that was copied directly from the source it cited. One reason it raised suspicion was that it included POV statements ("this is dichotomised thinking") and didn't flow well with the rest of the section, repeating some info from the paragraph above. Here is the reference in case anyone wants to rework any info that may be relevant to include in this section: http://www.bmj.com/cgi/content/full/316/7130/538 202.3.37.235 Orangeblossomspecial (talk) 11:12, 22 September 2008 (UTC)

Chron's disease, Ulcerative Colitis
Isn't the presence of ulcers a possible indication that a patient suffers from these diseases? —Preceding unsigned comment added by 67.182.219.132 (talk) 18:16, 26 November 2008 (UTC)

You can get gastric Crohn's (the disease is named after Crohn not "Chron") but it would be an uncommon cause of gastric ulceration- nearly all are related to either NSAID use or H.Pylori. Other rare causes include Zollinger Ellison .....

Ulcerative colitis affects the colon, rarely the latter portion of the small intestine. No gastric ulcers in UC. —Preceding unsigned comment added by Puldis (talk • contribs) 15:19, 18 May 2010 (UTC)

NG Tubes https://en.wikipedia.org/wiki/Nasogastric_aspiration can cause these ulcers; the irony being that the tubes are left in, the argument being they're needed to suck out the blood. — Preceding unsigned comment added by 67.188.161.192 (talk) 17:20, 12 July 2022 (UTC)

Definition of an ulcer
This business about an ulcer needing to be "equal to or greater than 0.5 cm" is not widely accepted or useful. Ulcers and erosions are mucosal defects; the difference betwee the two is that an ulcer involves the "full thickness" of the mucosa (ie. right down to the base of muscularis propria) and an erosion involves partial thickness (it not as far as the muscularis propria) Erosions TEND TO be smaller than ulcers but it is not helpful or pathologically correct to use a size criterion.

Isn't the presence of ulcers a possible indication that a patient suffers from these diseases? —Preceding unsigned comment added by 67.182.219.132 (talk) 18:16, 26 November 2008 (UTC)  —Preceding unsigned comment added by Marek1975 (talk • contribs)

Epidemiology infographic
The Epidemiology Section infographic is very unclear. No units are specified. I have no idea what it means.--Jp07 (talk) 20:23, 1 August 2011 (UTC)

Picture
I'm sure that picture of a "Deep gastric ulcer" is wonderfully illustrative to someone with the appropriate background, but it doesn't help me at all. How about a side by side, showing normal tissue versus ulcerated tissue? 'Cause I don't see anything wrong in that picture, and neither do most readers. 98.82.84.209 (talk) 19:01, 29 May 2012 (UTC)
 * I second your view. Brendon is  here  06:01, 5 June 2012 (UTC)

Stress as a cause
I believe the older view was that the condition was in part stress related and that later it was shown to be an infection. I think this misunderstanding of stress involvement is still prevalent and needs to be covered this article.2.101.241.253 (talk) 18:13, 9 October 2013 (UTC)


 * Actually, stress is still thought to be a factor (see for example here and here. We used to have a section in the article describing this, but it was removed a while ago for no apparent reason. I'll maybe re-add it. --sciencewatcher (talk) 00:31, 3 March 2015 (UTC)
 * yep you did. I reverted; my edit note said (fixed this time) :remove content that is original research and to the extent that it is sourced, is based on WP:PRIMARY sources that violate WP:MEDRS (please read MEDRS))"
 * here are some recent reviews:
 * Overmier JB, Murison R. Restoring psychology's role in peptic ulcer. Appl Psychol Health Well Being. 2013 Mar;5(1):5-27. doi: 10.1111/j.1758-0854.2012.01076.x. PMC 3613748
 * Konturek PC, et al Stress and the gut: pathophysiology, clinical consequences, diagnostic approach and treatment options. J Physiol Pharmacol. 2011 Dec;62(6):591-9. Review.
 * Fink G.Stress controversies: post-traumatic stress disorder, hippocampal volume, gastroduodenal ulceration. J Neuroendocrinol. 2011 Feb;23(2):107-17. doi: 10.1111/j.1365-2826.2010.02089.x. Review.
 * Yeomans ND. The ulcer sleuths: The search for the cause of peptic ulcers. J Gastroenterol Hepatol. 2011 Jan;26 Suppl 1:35-41. doi: 10.1111/j.1440-1746.2010.06537.x. Review.
 * good luck! Jytdog (talk) 01:12, 3 March 2015 (UTC)
 * good luck! Jytdog (talk) 01:12, 3 March 2015 (UTC)


 * Yes, you're right that we should be using good reviews for this -- thanks for taking the time to find those. It would have been nice if you had rewritten the section 2 years ago rather than just completely deleting it though :) --sciencewatcher (talk) 01:44, 3 March 2015 (UTC)
 * When one says "stress" causes PUD, they mean spending time intubated in the ICU, not having a hard day at work.
 * We state in the lead "stress due to serious illness" as a cause. I will take a look. Doc James  (talk · contribs · email) 04:07, 3 March 2015 (UTC)
 * Okay added some details/ Doc James  (talk · contribs · email) 04:34, 3 March 2015 (UTC)


 * I believe it's both actually, it's just that acute stress such as surgery causes it to occur much quicker. We actually have an article about the type of ulcer that is caused by surgery -- stress ulcer -- so I'll add a link to it. In terms of the chronic life stress, it still seems to be a factor as well. Anyway, your edit looks good to me. --sciencewatcher (talk) 05:31, 3 March 2015 (UTC)
 * Yes tentative evidence for life stress but it is somewhat controversial. Doc James  (talk · contribs · email) 05:35, 3 March 2015 (UTC)

Surgical treatment
The current treatment section seems to underplay the importance of surgical interventions in treatment of peptic ulcers. For example it makes the unsourced and, I believe, false claim that the introduction of PPI's has rendered surgical treatment by vagotomy "obsolete". Here is a medical textbook source

To quote that source: "What operations are used to treat duodenal ulcers?
 * Truncal vagotomy and pyloroplasty (V and P) or gastrojejunostomy
 * Truncal vagotomy and antrectomy with Billroth I or II anastomosis
 * Subtotal gastrectomy with Billroth I or II anastomosis
 * Selective vagotomy (just the vagal branches to the parietal cells in the stomach)
 * Total gastrectomy"

Reference
PGRandom (talk) 23:01, 24 February 2014 (UTC)

PPI infusion vs boluses
... in high-risk ulcers may be equivalent. 10.1001/jamainternmed.2014.4056 JFW &#124; T@lk  11:40, 7 November 2014 (UTC)

Diet: contradiction in article
In the leader, it states that,


 * "Diet does not play an important role in either causing or preventing ulcers."

while in the body it says,


 * "Studies in the varying occurrence of ulcers in third world countries despite high H. pylori colonization rates suggest dietary factors play a role in the pathogenesis of the disease."

Somebody more knowledgeable than me should take a look at this. -Xanthis (talk) 21:14, 22 March 2015 (UTC)\
 * Trimmed the poorly sourced one. Doc James  (talk · contribs · email) 02:30, 23 March 2015 (UTC)

William Dufty devotes a chapter "What the Specialists Say" of his book Sugar Blues to the question of diet and peptic ulcer. He cites John Yudkin's experience in 1950 in cutting down on sugar and finding relief from his diagnosed ulcers (p 187,8). Yudkin apparently wrote about it in Sweet and Dangerous(1972). The argument is that "Sugar irritates the lining of the upper alimentary canal, the esophagus, stomach and duodenum". Apparently Yudkin also conducted some (partially) controlled experiments to validate his experience, and found confirmation of the efficacy of the reduced-sugar diet.Rgdboer (talk) 20:50, 26 April 2015 (UTC)

External links modified
Hello fellow Wikipedians,

I have just added archive links to 1 one external link on Peptic ulcer. Please take a moment to review my edit. If necessary, add after the link to keep me from modifying it. Alternatively, you can add to keep me off the page altogether. I made the following changes:
 * Added archive https://web.archive.org/20110618102000/http://www3.interscience.wiley.com:80/journal/120151138/abstract?CRETRY=1&SRETRY=0 to http://www3.interscience.wiley.com/journal/120151138/abstract?CRETRY=1&SRETRY=0

When you have finished reviewing my changes, please set the checked parameter below to true to let others know.

Cheers. —cyberbot II  Talk to my owner :Online 18:36, 28 August 2015 (UTC)

Avoiding kissing and other means to avoid H.pylori in Western World (Western Europe)
Wikipedia says: "Transmission is by food, contaminated groundwater, and through human saliva (such as from kissing or sharing food utensils)". I did not find the word "kiss" or "kissing" in the reference. How risky is it to kiss someone who has H.pylori? H.Pylori may require antibiotics, so it is better to avoid it! Any other tips to avoid h.pylori? ee1518 (talk) 12:30, 25 September 2015 (UTC)

Lancet
10.1016/S0140-6736(16)32404-7 JFW &#124; T@lk  20:07, 6 August 2017 (UTC)

Wording
" An ulcer in the stomach is called a gastric ulcer, while that in the first part of the intestines is a duodenal ulcer."

"Termed" is not needed. Doc James (talk · contribs · email) 04:49, 27 February 2019 (UTC)

Diagnostic breath test
The use of C14-labelled urea is outdated. The tracer now used is the much cheaper and non-hazardous C13-labelled urea. C13 can be measured on a bench top instrument "While you wait." It is probably also worth mentioning that the breath test has a somewhat better performance than the stool antigen test - on the basis of percentage false positives and false negatives, as well as ease of administration. 2407:7000:8222:6100:8434:9C60:1F25:99F9 (talk) 07:13, 2 July 2022 (UTC)

Deaths
https://pubmed.ncbi.nlm.nih.gov/8189011/

Japan: 105,000 USA: 103,000

Per year. I only read the first line, and the death rate Wikipedia quotes: 3,000

Another source (I think government) said 1,000 new cases per year.

I'm not going to edit anything because I know peptic ulcers aren't usually fatal, but I want to edit the simple.wikipedia article. So the death rates in the USA are good to use (I don't think UK/Scot NHS website covers deaths). China will probably hide their statistics and could be different to the US/UK

Maybe I'll find a reference for https://simple.m.wikipedia.org/wiki/Peptic_ulcer but not change the en.wikipedia article. Hopefully that isn't a mistake W&#59;ChangingUsername (talk) 13:09, 22 May 2024 (UTC)

Unverified Claim
I was unable to verify the claim that people over 45 could have an immediate esophagogastroduodenoscopy in my research. If nobody else can verify this, I will remove this sentence. Garsh (talk) 00:28, 7 June 2024 (UTC)