Gastrointestinal system: peptic ulcer

• A peptic ulcer is a sore that develops on the lining of the stomach, small intestine, or esophagus.

• It occurs when the protective mucous layer is eroded by stomach acids.

• Peptic ulcers are classified into gastric ulcers (in the stomach) and duodenal ulcers (in the upper part of the small intestine).

Gastrointestinal system: peptic ulcer

Causes

1. Helicobacter pylori Infection: A common bacterial infection that can damage the stomach lining.

2. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Long-term use of NSAIDs (e.g., ibuprofen, aspirin) can irritate and inflame the stomach lining.

3. Excess Acid Production: Conditions like Zollinger-Ellison syndrome can increase stomach acid production.

4. Lifestyle Factors: Smoking, excessive alcohol consumption, and stress can exacerbate ulcer formation.

Symptoms

1. Abdominal Pain: Burning or gnawing pain, often in the upper abdomen, that may improve with eating (duodenal ulcer) or worsen with eating (gastric ulcer).

2. Bloating and Belching

3. Heartburn

4. Nausea and Vomiting

5. Dark, Tarry Stools: Indicative of bleeding.

6. Vomiting Blood: In severe cases.

Diagnosis

1. Endoscopy: A flexible tube with a camera is used to view the ulcer.

2. Barium Swallow: X-rays taken after drinking a barium solution to highlight the digestive tract.

3. Tests for H. pylori: Blood, stool, or breath tests to detect H. pylori infection.

Pathophysiology of Peptic Ulcer

1. Helicobacter pylori Infection: Bacteria cause chronic inflammation and damage to the stomach or duodenal lining.

2. NSAID Use: Inhibits cyclooxygenase (COX) enzymes, reducing protective prostaglandins in the gastric mucosa.

3. Acid and Pepsin: Excessive gastric acid and pepsin can erode the mucosal lining, forming ulcers.

4. Mucosal Defense Mechanism Impairment: Reduced production of mucus and bicarbonate, leading to increased susceptibility to acid damage.

Treatment

1. Medications:

• Proton Pump Inhibitors (PPIs): Reduce stomach acid production (e.g., omeprazole, lansoprazole).

• H2-Receptor Antagonists: Also reduce stomach acid (e.g., ranitidine, famotidine).

• Antibiotics: To eradicate H. pylori infection.

• Antacids: Neutralize stomach acid and provide quick pain relief.

• Cytoprotective Agents: Protect the stomach lining (e.g., sucralfate, misoprostol).

2. Lifestyle Changes:

• Avoiding NSAIDs.

• Limiting alcohol and quitting smoking.

• Eating a balanced diet and managing stress.

Complications

1. Internal Bleeding: Leading to anemia or severe blood loss.

2. Perforation: A hole in the stomach or duodenal wall.

3. Gastric Outlet Obstruction: Blockage preventing food from leaving the stomach.

4. Peritonitis: Infection of the abdominal cavity if the ulcer perforates.