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- 02/12/2024
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Peptic acid disease (PAD) is one of the most frequent reasons for visits to the physician in general medical practice, both in emergency departments and outpatient clinics.
Peptic ulcer disease (PUD), or peptic acid disease, encompasses a group of conditions that have a common origin in stomach hydrochloric acid, the enzyme pepsin and an imbalance between the protective factors of the upper gastrointestinal tract and the factors that contribute to digestion, which occasionally injure mucosal tissues.
In Mexico, a screening study in an open population showed an overall frequency of Hp infection of 66%, observing that this frequency increased with increasing age. In patients with PAD symptomatology, they report a prevalence of 67% when sent for endoscopic study.
The incidence and prevalence of uncomplicated acid peptic disease have declined in recent years, largely due to the availability of treatment to eradicate Helicobacter pylori (Hp) and the decreasing prevalence of this infection. However, the use of acetylsalicylic acid (ASA) and other nonsteroidal anti-inflammatory drugs (NSAIDs) that are associated with adverse gastrointestinal events is increasing. Helicobacter pylori (Hp) y la prevalencia decreciente de esta infección. Sin embargo, el uso de ácido acetilsalicílico (AAS) y otros medicamentos antiinflamatorios no esteroides (AINE) que están asociados con eventos gastrointestinales adversos se está incrementando.
The main risk factors associated with the occurrence of PAD are the intake of non-steroidal anti-inflammatory drugs (NSAIDs), age over 65 years, smoking, combined used of NSAIDs and colonization by Hp, as already mentioned, in the gastric mucosa.
Among the most significant deceases due to their frequency in the population as well as their potential severity in the absence of treatment are gastritis, gastric or duodenal ulcer (the latter more frequent in young people), esophagitis and gastroesophageal reflux disease: factors that delay or prevent the effectiveness of treatment are the presence of Hp, the frequent use of anti-inflammatory drugs and Zollinger-Ellison syndrome, a disease associated with stomach cancer. Hp, el uso frecuente de antiinflamatorios y el síndrome de Zollinger-Ellison, enfermedad asociada a cáncer de estómago.
The most common and delicate complication of PAD is hermorrhage, which usually occurs in 20 to 25% of patients and its frequency has increased in recent years. More than half of the patients who have had a bleeding event present a new episode within 10 to 15 years.
The medical treatment of PAD is diverse because of the different measures that can be adopted and the drugs that can be prescribed. From the hygienic-dietary measures that have shown discrete benefits (raising the head of the bed or decreasing weight and abdominal circumference), through gastric mucosa protectors such as sucralfate and antacids with magnesium and aluminum derivatives, to the latest innovative drugs such as proton pump inhibitors (PPIs) with high and sustained effectiveness, therapy has had significant advances in the acute and chronic management of this group of conditions. On the other hand, surgery and complex endoscopic treatments are reserved for the most complicated cases of those with high relapse frequency and risk of life-threatening complications.
PPIs represent one of the most important therapeutic advances por PAD. Cure rates of different variants of PAD are the highest for more than 50 years and the decrease in surgical complications has been most remarkable.
In the treatment with proton pump inhibitors (PPIs) such as omeprazole, pantoprazole, esmeprazole and lanzoprazole, as the most representative of the therapeutic group, it has been observed that with few adverse events, the acceptance by institutions, physicians and patients is almost 100%.
COMPLICATIONS OF PEPTIC-ACID DISEASE (PAD)
The incidence and prevalence of uncomplicated PAD have decreased in recent years, largely due to the availability of more effective treatments and those to erradicate Helicobacter pylory. Helicobacter pylori.
The incursión of PPIs in the treatment of PAD has managed to reduce the surgical complications of the disease.
The widespread use of acetylsalicylic acid (ASA) and other nonsteroidal anti-inflammatory drugs (NSAIDs) associated with PAD has increased in the general population, which has not led to a real decrease in the incidence of the disease.
Given the trade-off between better treatments and increased NSAID consumption, there may not be a directly proportional decrease in PAD complications such as bleeding or perforation, as other added risk factors allow for recurrence of complications in certain types of patients.
History of having been treated with PPIs may reduce the risk of bleeding from PAD.
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