Peptic Ulcer disease – B. Pharma 2nd Semester Pathophysiology notes pdf

Peptic Ulcer Disease

peptic-ulcer

Objective

At the end of this lecture, student will be able to

       Define  peptic ulcer disease

       Explain the  etiology of peptic ulcer disease

       Describe the pathophysiology of peptic ulcer disease

Peptic Ulcer

       Breach in the mucosa of the alimentary tract, which extends through the muscularis mucosa into the submucosa or deeper

       Chronic  and most often solitary, lesions

       Any  portion of gastrointestinal tract exposed to the aggressive action of acid-peptic juices

       Erosion of GI mucosa resulting from  digestive action of HCl and pepsin

Duodenal vs gastric ulcers

DUODENAL GASTRIC
INCIDENCE More common Less common
ANATOMY First part of duodenum – anterior wall Lesser curvature of stomach
DURATION Acute or chronic Chronic
MALIGNANCY Rare Benign or malignant
peptic-ulcer

Peptic ulcer

     Imbalance between aggressive & protective factors

Aggressive factors

Gastric acid

Proteolytic enzyme

Protective factors

Mucosal layer

Bicarbonate secretion

Prostaglandins

Risk factors of peptic ulcers

       Helicobacter pylori

       Non Steroidal Anti-inflammatory Drugs

       Steroid therapy

       Smoking and Excess alcohol intake

       Genetic factors

       Zollinger Ellison syndrome – rare syndrome caused by gastrin-secreting tumour

       Blood group O   and Hyperparathyroidism

Pathophysiology of peptic ulcers

Gastric acid and pepsin

       Potential for producing mucosal damage is related to the secretion of gastric (hydrochloric) acid and pepsin

       Hydrochloric acid  – parietal cells – receptors for histamine, gastrin, and acetylcholine

       Increased acid secretion – duodenal ulcers –  HP infection

       Patients with ZES  have gastric acid hypersecretion resulting from a gastrin-producing tumor

       Patients with gastric ulcer – normal or reduced rates of acid secretion

Mucosal defense mechanisms

       Protect the gastroduodenal mucosa from noxious endogenous and exogenous substances

       Bicarbonate barrier protect the stomach from the acidic contents

       Epithelial cell restitution, growth, and regeneration

       Maintenance of mucosal integrity and repair is mediated by the production of endogenous prostaglandins

H. pylori infection

Mechanisms include:

1)     Direct mucosal damage

2)     Alterations in the host immune/inflammatory response

3)     Hypergastrinemia leading to increased acid secretion

       Virulence factors (vacuolating cytotoxin, cytotoxin-associated gene protein, and growth inhibitory factor)

       Elaborating bacterial enzymes (lipases, proteases, and urease), and adherence

       Lipases and proteases degrade gastric mucus

       Ammonia produced by urease – toxic to epithelial cells

       Bacterial adherence enhances uptake of toxins into gastric epithelial cells

NSAID Induced

       Direct or topical irritation of the gastric epithelium and 

       Systemic inhibition of endogenous mucosal prostaglandin synthesis

       Inhibit both COX-1 and COX-2 to varying degrees

       Neutrophil adherence may damage the vascular endothelium

       Lead to a reduction in mucosal blood flow

       Liberate oxygen-derived free radicals and proteases

Symptoms of peptic ulcers

       Abdominal pain that is often epigastric  – burning –   vague discomfort, abdominal fullness, or cramping

        A typical nocturnal pain that awakens the patient from sleep

        Severity of ulcer pain varies from patient to patient

       May be seasonal, occurring more frequently in the spring or fall

       Episodes of discomfort usually occur in clusters lasting up to a few weeks followed by a pain-free period or remission lasting from weeks to years

       Heartburn, belching, and bloating often accompany the pain

        Nausea, vomiting, and anorexia

Complications of peptic ulcers

       Obstruction – pyloric stenosis and duodenal stenosis

       Hemorrhage – blood in stools; if chronic – leads to anemia

       Perforation

       Malignant transformation to carcinoma

Seeking Treatment

1. Medications

Doctors often prescribe medications to treat peptic ulcers. These may include antibiotics to eliminate H. pylori, proton pump inhibitors (PPIs) to reduce stomach acid, and antacids to alleviate symptoms.

2. Lifestyle Changes

In addition to medications, making certain lifestyle changes can help manage peptic ulcers. This includes quitting smoking, reducing alcohol intake, and avoiding NSAIDs.

3. Surgery

In severe cases where medications and lifestyle changes don’t provide relief, surgery may be necessary to remove the ulcer or repair the damaged tissue.

Preventing Peptic Ulcers

1. H. pylori Screening

Regular screening for H. pylori infection is essential, especially for those with a family history of ulcers or a known exposure to the bacterium.

2. Medication Use

If you need to take NSAIDs for a medical condition, consult with your healthcare provider and consider protective medications to reduce the risk of ulcers.

3. Healthy Eating Habits

Maintain a balanced diet rich in fruits, vegetables, and fiber. Avoid spicy foods and large meals, as these can exacerbate ulcer symptoms.

Summary

       Ulcers are defined as a breach in the mucosa of the alimentary tract, which extends through the muscularis mucosa into the submucosa or deeper

       Etiological factors are helicobacter pylori infection, nonsteroidal anti-inflammatory drugs, critical illness, hypersecretion of gastric acid , viral infections ,vascular insufficiency

       HP infection alters host inflammatory response and damages epithelial cells directly by cell-mediated immune system whereas NSAID cause direct irritation to epithelium and decrease PGE2

FAQs

  1. Are all stomach pains indicative of peptic ulcers? Not all stomach pains are due to peptic ulcers. However, if you experience persistent, burning abdominal pain, it’s advisable to consult a healthcare professional for evaluation.
  2. Can stress cause peptic ulcers? While stress can exacerbate ulcer symptoms, it is not a direct cause of peptic ulcers. They are primarily caused by factors like H. pylori infection and NSAID use.
  3. Is surgery the only option for severe peptic ulcers? Surgery is considered when other treatments are ineffective. It’s not the first choice and is typically reserved for cases where complications like bleeding or perforation occur.
  4. How long does it take to heal a peptic ulcer with medication? The healing time varies from person to person. It can take several weeks to a few months for peptic ulcers to heal with medication and lifestyle changes.
  5. Can I prevent peptic ulcers if I have a family history of the condition? While a family history increases your risk, following preventive measures like H. pylori screening and healthy eating habits can help reduce your chances of developing peptic ulcers.

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