ENDOSCOPY to examine the ESOPHAGUS, stomach,
and duodenum often makes the diagnosis, allow-
ing the gastroenterologist to visualize the ulcers
and extent of damage. Biopsy of a tissue sample or
an urea breath test can determine whether H.
pyloriinfection is present.
Treatment Options and OutlookH. pyloriinfection accounts for nearly 80 percent
of peptic ulcer disease. Treatment with appropriate
ANTIBIOTIC MEDICATIONS to eradicate the BACTERIA
allows the ulcers to heal. Chronic NSAID use is
the second-most common cause of peptic ulcer
disease; ulcers typically heal when the person
stops taking the NSAID. Regardless of cause, the
treatment of choice for peptic ulcer disease is acid-
reducing medication to decrease irritation to the
damaged tissue.
Gastroenterologists typically prescribe H 2 ANTAG-
ONIST (BLOCKER) MEDICATIONS or PROTON PUMP
INHIBITOR(PPI) MEDICATIONSfor this purpose. After
the ulcers heal, most people no longer need to
take the medication. Severe ulcers may require
surgery, particularly if they are bleeding. The pri-
mary complication of peptic ulcer disease is perfo-
ration (an ulcer that “eats through” or penetrates
the wall of the duodenum or stomach), which can
result in life-threatening bleeding and usually
requires surgery. There also is some evidence link-
ing long-term peptic ulcer disease, particularly
that resulting from H. pylori infection, with an
increased risk for STOMACH CANCER.
Risk Factors and Preventive MeasuresDoctors once believed stress was the primary
cause of peptic ulcer disease, though now know
this is not the case. The causes of peptic ulcer dis-
ease, are largely treatable (H. pyloriinfection) or
preventable (NSAID overuse).
See also GASTROESOPHAGEAL REFLUX DISORDER
(GERD); MULTIPLE ENDOCRINE NEOPLASIA(MEN); RISK
FACTORS FOR CANCER; ZOLLINGER-ELLISON SYNDROME.
percutaneous liver biopsy A diagnostic proce-
dure for removing a tissue sample from the LIVER.
The doctor typically performs percutaneous liver
biopsy on an outpatient basis in a hospital setting.
Most people prefer to receive a mild sedative
before the procedure. After anesthetizing the
abdominal SKINand tissue above the liver, the doc-
tor makes a tiny incision and inserts a special
biopsy needle. The needle withdraws a core of
liver tissue, which a laboratory then analyzes to
determine the nature and structure of cells and
other substances it contains. Percutaneous liver
biopsy helps diagnose numerous conditions affect-
ing the liver, including HEPATITIS, CIRRHOSIS,LIVER
FAILURE, STEATOHEPATITIS, and LIVER CANCER. Though
minimally invasive, percutaneous liver biopsy
exposes the liver to several risks including INFEC-
TION, INFLAMMATION, and bleeding. These complica-
tions are uncommon though can be serious.
See also LIVER FUNCTION TESTS.peristalsis The rhythmic waves of contraction
that move food through the gastrointestinal tract.
Pressure against the inner walls of the intestines,
such as occurs when food enters an intestinal seg-
ment, signals the muscles to contract and relax in
a progressive pattern. The muscles ahead of the
pressure relax, widening the intestinal passage,
and the muscles behind the pressure contract,
narrowing the passage. This action “massages” the
intestinal contents forward. Peristalsis is totally
involuntary, under the control of the autonomic
NERVOUS SYSTEM.
See also BORBORYGMUS; BOWEL SOUNDS.peritonitis INFLAMMATION and INFECTION of the
peritoneal membrane that encases the contents of
the abdominal cavity. Peritonitis usually indicates
a perforation of the intestinal tract that allows
intestinal content, including normally present BAC-
TERIA, to spill into the abdominal cavity. Such a
breach may occur as the result of APPENDICITISor
COLITIS, or with INFLAMMATORY BOWEL DISEASE(IBD)
or DIVERTICULAR DISEASEthat erodes through the
wall of the intestine. Peritoneal ABSCESSalso often
causes peritonitis. Peritoneal dialysis for KIDNEY
failure, which circulates fluid within the peri-
toneal cavity to draw toxins from the body, may
introduce bacteria into the peritoneal cavity to
cause peritonitis.Peritonitis is potentially life-threaten-
ing and requires emergency treatment
and usually surgery.82 The Gastrointestinal System