None of the funding or supportive agencies were involved in the design or conduct of the study; collection, management, analysis, or interpretation of the data; or preparation, review, or approval of the manuscript. Duality of Interest. Author Contributions. References 1. Brand PW. Tenderizing the foot. Foot Ankle Int ;— 2. The aetiology of diabetic neuropathic ulceration of the foot. Br J Surg ; 1—6 3. Peak plantar shear and pressure and foot ulcer locations: a call to revisit ulceration pathomechanics.
Diabetes Care ; e—e 4. Association between plantar temperatures and triaxial stresses in individuals with diabetes. Diabetes Care ;e—e 5. Yavuz M. American Society of Biomechanics Clinical Biomechanics Award plantar shear stress distributions in diabetic patients with and without neuropathy. Clin Biomech Bristol, Avon ; — e Related Papers. By Lawrence Lavery. Diabetic Foot Biomechanics and Gait Dysfunction.
By Bijan Najafi. Role of neuropathy and high foot pressures in diabetic foot ulceration. By Aristidis Veves. Download pdf. Log in with Facebook Log in with Google. Remember me on this computer. Enter the email address you signed up with and we'll email you a reset link. Need an account? Click here to sign up. PPIs block acid production in the stomach, providing relief of symptoms and promote healing. Treatment may be incorporated with calcium supplements as long-term use of the PPIs can increase the risk of bone fractures.
Corticosteroids, bisphosphonates, and anticoagulants should also be discontinued if possible. First-line treatment for H. Pantoprazole, clarithromycin, and metronidazole, or amoxicillin are used for 7 to 14 days. If first-line therapy fails, quadruple therapy with bismuth and different antibiotics is used. Surgical treatment is indicated if the patient is unresponsive to medical treatment, noncompliant, or at high risk of complications.
A refractory peptic ulcer is one over 5 mm in diameter that does not heal despite weeks of PPI therapy. The common causes are persistent H. If the ulcer persists despite addressing the above risk factors, patients can be candidates for surgical treatment. Surgical options include vagotomy or partial gastrectomy. The following conditions can present with symptoms similar to peptic ulcer disease and it is important to be familiar with their clinical presentation in order to make the correct diagnosis.
The prognosis of peptic ulcer disease PUD is excellent after the underlying cause is successfully treated. Recurrence of the ulcer may be prevented by maintaining good hygiene and avoiding alcohol, smoking, and NSAIDs. NSAID-induced gastric perforation occurs at a rate of 0. However, unlike in the past, mortality rates for peptic ulcer disease have decreased significantly.
Peptic ulcer disease PUD if not diagnosed and treated promptly can lead to serious complications. Following complications can occur in PUD:. Patients with peptic ulcer disease PUD should be counseled about potentially injurious agents like nonsteroidal anti-inflammatory drugs NSAIDs , aspirin, alcohol, tobacco, and caffeine. Obesity has a strong association with peptic ulcer disease, and patients should be asked to lose weight.
Stress reduction counseling can be helpful in some cases. Ulcers are differentiated from erosions based on size. Lesions less than 5 mm in diameter are termed erosions, whereas lesions greater than 5 mm in diameter are termed ulcers. A gastrin-producing endocrine tumor causes Zollinger-Ellison syndrome or gastrinoma usually arises from the pancreas or duodenum. It results in multiple ulcers in the duodenum and jejunum. It can be diagnosed by measuring serum gastrin levels.
An evidence-based approach to peptic ulcer disease is recommended. PUD is a very common disorder that affects millions of people.
When left untreated, it has significant morbidity. The majority of patients with PUD present to their primary caregiver, but others may present to the emergency department, urgent care clinic, or an outpatient clinic.
Because the presentation of PUD is often vague, healthcare workers, including nurses, need to be aware of this diagnosis. The abdominal pain can mimic a number of other pathologies and consequently lead to a delay in treatment.
Once the diagnosis is made, the key is to educate the patient on lifestyle changes, which include discontinuation of smoking, abstaining from alcohol and caffeinated beverages, and avoid consumption of too many NSAIDs. Gastroenterology nurses monitor patients, provide education, and keep the team updated on the patient's condition. The pharmacist should educate the patient on medication compliance to obtain symptom relief and a cure.
A dietary consult should be sought as there is evidence that obesity may be a trigger factor for peptic ulcer disease. Only through a team approach can the morbidity of peptic ulcer disease be decreased.
For most patients with PUD who are treated with the triple regimen or PPI, the outcomes are excellent, but recurrence of symptoms is not uncommon. This book is distributed under the terms of the Creative Commons Attribution 4.
Turn recording back on. National Center for Biotechnology Information , U. StatPearls [Internet]. Search term. Peptic Ulcer Disease Talia F. Author Information Authors Talia F. Continuing Education Activity Peptic ulcer disease is characterized by discontinuation in the inner lining of the gastrointestinal GI tract because of gastric acid secretion or pepsin. Introduction Peptic ulcer disease PUD is characterized by discontinuation in the inner lining of the gastrointestinal GI tract because of gastric acid secretion or pepsin.
Urease: The secretion of urease breaks down urea into ammonia and protects the organism by neutralizing the acidic gastric environment. Pathophysiology The peptic ulcer disease PUD mechanism results from an imbalance between gastric mucosal protective and destructive factors. Risk factors predisposing to the development of PUD: H.
Histopathology Gastric ulcers are most commonly located on the lesser curvature, whereas duodenal ulcers are most common at the duodenal bulb.
History and Physical Signs and symptoms of peptic ulcer disease may vary depending upon the location of the disease and age. Common signs and symptoms include: Epigastric abdominal pain. The American Society of Gastrointestinal Endoscopy has published guidelines on the role of endoscopy in patients presenting with upper abdominal pain or dyspeptic symptoms suggestive of PUD. Anyone with the presence of alarm symptoms should undergo EGD irrespective of age. Urea breath test: High sensitivity and specificity.
It may be used to confirm eradication after 4 to 6 weeks of stopping treatment. In the presence of urease, an enzyme produced by H. Endoscopic biopsy: Culture is not generally recommended as it is expensive, time-consuming, and invasive. It is indicated if eradication treatment fails or there is suspicion about antibiotic resistance. Biopsies from at least sites are necessary to increase sensitivity. Gastric ulcers are commonly located on the lesser curvature between the antrum and fundus.
The majority of duodenal ulcers are located in the first part of the duodenum. Refractory Disease and Surgical Treatment Surgical treatment is indicated if the patient is unresponsive to medical treatment, noncompliant, or at high risk of complications. Differential Diagnosis The following conditions can present with symptoms similar to peptic ulcer disease and it is important to be familiar with their clinical presentation in order to make the correct diagnosis.
Gastritis - an inflammatory process of the gastric mucosa from immune-mediated or infectious etiology presenting with upper abdominal pain and nausea. Clinical presentation is very similar to that of peptic ulcer disease. Gastroesophageal reflux disease GERD - patients usually describe a burning sensation in the epigastrium and lower retrosternal area, excessive salivation, or intermittent regurgitation of food material.
Gastric cancer - apart from abdominal pain, patients usually describe alarm symptoms like weight loss, melena, recurrent vomiting, or evidence of malignancy elsewhere in case of metastasis. Pancreatitis - epigastric or right upper quadrant pain that is more persistent and severe, worse in the supine position, and patients usually have a history of alcoholism or gallstones.
Biliary colic - intermittent, severe deep pain in the right upper quadrant or epigastrium precipitated by fatty meals. Cholecystitis - right upper quadrant or epigastric pain that usually lasts for hours and is exacerbated by fatty meals and is associated with nausea and vomiting.
Fever, tachycardia, positive Murphy sign, leukocytosis, and abnormal liver functions help further distinguish this from biliary colic. Myocardial infarction - especially in the inferior wall and right ventricular involvement, sometimes patients can present with epigastric pain with nausea and vomiting. Mesenteric ischemia - while acute mesenteric ischemia presents with severe, acute onset abdominal pain; the chronic variant usually presents with ongoing post-prandial epigastric pain [13] and can be mistaken for peptic ulcer disease.
Older age, presence of risk factors for atherosclerosis, and weight loss should prompt a workup for the same. Mesenteric vasculitis - unexplained abdominal symptoms with or without lower gastrointestinal bleeding in a patient with other features from underlying systemic vasculitis should raise the suspicion of mesenteric vasculitis. Prognosis The prognosis of peptic ulcer disease PUD is excellent after the underlying cause is successfully treated. Complications Peptic ulcer disease PUD if not diagnosed and treated promptly can lead to serious complications.
Following complications can occur in PUD: Upper gastrointestinal bleeding. Deterrence and Patient Education Patients with peptic ulcer disease PUD should be counseled about potentially injurious agents like nonsteroidal anti-inflammatory drugs NSAIDs , aspirin, alcohol, tobacco, and caffeine.
Pearls and Other Issues Ulcers are differentiated from erosions based on size. Enhancing Healthcare Team Outcomes An evidence-based approach to peptic ulcer disease is recommended. Review Questions Access free multiple choice questions on this topic. Comment on this article. References 1. Peptic Ulcer Disease and Helicobacter pylori infection.
Mo Med. Risk of upper and lower gastrointestinal bleeding in patients taking nonsteroidal anti-inflammatory drugs, antiplatelet agents, or anticoagulants.
Clin Gastroenterol Hepatol. Role of Helicobacter pylori infection and non-steroidal anti-inflammatory drugs in peptic-ulcer disease: a meta-analysis. Snowden FM.
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