Peptic ulcer

Peptic ulcer : definition , types, difference between gastric and duodenal ulcer, etiology, Pathophysiology ,Sign and symptoms, Complication, diagnostic test

1. PEPTIC ULCERS
By : Mistry Hardi N.
SY student B.pharm
Anand Pharmacy College,Anand.

2. DEFINATION :
Peptic ulcer is a lesion in the lining (mucosa) of the digestive
tract, typically in the stomach,duodenum or lower esophagus
,caused by the digestive action of person and stomach acid.
OR
Peptic ulcer is sores in mucosa of stomach or duodenum.
TYPES OF ULCERS :
1.Gastric ulcer
2.Duodenal ulcer

3. Gastric ulcer and Duodenal ulcers
Factors Gastric ulcer Duodenal ulcer
Defination Ulcerations occur
in stomach
Ulcerations occur
in Duodenum
Age Middle age 50-60Any age
specifically 30-40
Sex More in female More in male
Onset Immediately after
eating
2-3 hours after
eating
Pain No pain at hours of
sleep (because
HCL production
decreases at hours
of sleep)
Pain at hours of
sleep(because
gastric emptying
continues at hours
of sleep)

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Factors Gastric ulcer Duodenal ulcer
Aggravated by By Eating (because
acid secretion
increases at meal
time)
By empty stomach
(acid without food
Leads to pain)
Relieved by Lying down or
vomiting (because
acid is expelled
out)
Eating (because the
pyloric sphincter,at
the junction of
stomach and
duodenum,closes
upon eating to
concentrate food in
the stomach)
Weight Weight loss Weight gain

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Factors Gastric ulcer Duodenal ulcer
Duration Few weeks 1-2 months
Vomiting Common (to
relieve pain)
Uncommon

6. Etiology:
1. H. Pylori infections :
90% have this bacterial infection.
Passed from fecal-oral route or oral-oral route.
3. Gender :
Duodenal ulcer mainly occur in male
Whereas Gastric ulcer mainly occur in female
2.Lifestyle:
Smoking
Acidic drinks
Medication

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4.Gentic Factors:
More likely if family members had.
5. Age:
Duodenal ulcers mainly occurs at 30-40 years of
age
Gastric ulcer mainly occur at age over 50 years.
6. Other Factors :
Stress.

8. Pathophysiology:
Peptic ulcers are caused by an Imbalance between
protective factors(Defensive factors) and damaging
factors(Aggressive factors) in gastrointestinal mucosa.
In normal phyisology there is a balance between
aggressive factors and Defensive factors as a consequence
ulcer is not developed.
But in pathologic conditions there is imbalance between
aggressive factors and Defensive factor i.e Aggressive
factors increase and Defensive factor decrease as a result
ulcer develops
Mucus
Bicarbonate (HCO3-)
Epithelial repair
Defensive factors Aggressive factors
Pepsin
HCL
NSAIDs
H. Pyloric

9. Role of H. Pyloric:
H.pylori produces an enzyme called urease which convert
the urea into ammonia and this ammonia is toxic to
mucosa it leads to direct death of cells
NH4 NH3
H.Pylori also has an adhesion molecules which leads to
the sticking of h.pylori to GIT.
H.pylori also produces an enzyme called as catalase which
inactivate the neutrophile action.

10. Signs and Symptoms :
• Burning stomach pain
• Feeling of fullness, bloating or belching
• Fatty food intolerance
• Heartburn
• Nausea
The most common peptic ulcer symptom is burning
stomach pain. Stomach acid makes the pain worse, as
does having an empty stomach. The pain can often be
relieved by eating certain foods that buffer stomach acid
or by taking an acid-reducing medication, but then it may
come back. The pain may be worse between meals and at
night.

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Nearly three-quarters of people with peptic ulcers don't
have symptoms. Less often, ulcers may cause severe signs
or symptoms such as:
• Vomiting or vomiting blood —which may appear red or
black
• Dark blood in stools, or stools that are black or tarry
• Trouble breathing
• Feeling faint
• Nausea or vomiting
• Unexplained weight loss
• Appetite changes

12. Complications :
Acute and subacute peptic ulcers usually heal without
leaving any visible scar. However, healing of chronic,
larger and deeper ulcers may result in complications.
These are as follows:
1. Obstruction: Development of fibrous scar at or near the
pylorus results in pyloric stenosis
In the case of healed duodenal ulcer, it causes duodenal
stenosis.
Healed ulcers along the lesser curvatures may produce
‘hourglass’ deformity due to fibrosis and contraction.
2.Haemorrhage:Minor bleeding by erosion of small blood
vessels in the base of an ulcer occurs in all the ulcers and
can be detected by testing the stool for occult blood.

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Chronic blood loss may result in iron deficiency anaemia.
Severe bleeding may cause ‘coffee ground’ vomitus or
melaena.
A penetrating chronic ulcer may erode a major artery
(e.g. left gastric, gastroduodenal or splenic artery) and
cause a massive and severe hematemesis and sometimes
death.
3. Perforation : A perforated peptic ulcer is an acute
abdominal emergency. Perforation occurs more commonly in
chronic duodenal ulcers than chronic gastric ulcers.
Following sequelae may result:

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i) On perforation the contents escape into the lesser sac or
into the peritoneal cavity, causing acute peritonitis.
ii) Air escapes from the stomach and lies between the liver
and the diaphragm giving the characteristic radiological
appearance of air under the diaphragm.
iii) Subphrenic abscess between the liver and the diaphragm
may develop due to infection.
iv) Perforation may extend to involve the adjacent organs
e.g. the liver and pancreas.

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4. Malignant transformation :The dictum ‘cancers ulcerate
but ulcers rarely cancerate’ holds true for most peptic
ulcers. A chronic duodenal ulcer never turns malignant,
while less than 1% of chronic gastric ulcers may transform
into carcinoma.

16. Diagnostic test:
Three types of tests are available to diagnose a peptic
ulcer, They are :
1.Upper gastrointestinal series (UGI):
For this procedure, you’ll drink a thick liquid called barium
(barium swallow).
Then a technician will take anX-rayof yourstomach,
esophagus,andsmall intestine.
The liquid will make it possible for your doctor to view and
treat the ulcer.

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2. Upper endoscopy or Esophagogastrodeuodenoscopy (EGD):
In this procedure, your doctor inserts a long tube with a
camera down your throat and into your stomach and small
intestine to examine the area for ulcers.
This instrument also allows your doctor to remove tissue
samples for examination.
Not all cases require an upper endoscopy. However, this
procedure is recommended for people with a higher risk of
stomach cancer.

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3. Urea breath test:
Used to detect the H.pylori .
Patient drinks the carbon enriched urea solution.
Exhaled carbon dioxide is then measured.

19. Reference:
Harsh Mohan –Text book of pathophysiology,sixth edition.
Medically reviewed bySaurabh Sethi, M.D., MPH—Written
byShannon Johnsonon December 4, 2018, from
https://www.healthline.com/health/stomach-
ulcer#overview
Medically reviewed byGraham Rogers, M.D.—Written
byValencia Higuera—Updated on April 13, 2020, from
https://www.healthline.com/health/peptic-
ulcer#diagnosis