What is Peptic ulcer, cause, symptoms, and treatment 

Hello, today I am going to tell you about a disease which has more than 1 million cases in a year, this disease is known as peptic ulcer 

After reading this article you will get to know about its 

• Definition and meaning 
• Causes 
• Symptoms 
• Types 
• Treatment 

Peptic ulcer 

• An ulcer is a break in the lining of the mucus membrane( surrounds the stomach and duodenum)

Types 

Duodenal ulcer  (male:female = 5:1) more common just right after pyloric sphincter 

Stomach ulcer (male:female=2:1)  common in lesser curvature of stomach 

• Duodenal ulcers are more common comparatively 
• It can be acute or chronic, in chronic fibrosis is seen due to repeated healing and destruction fibrosis occurs.

Normal physiology of the stomach 

• The gastrointestinal tract(GIT) is lined with mucosa, it has 3 layers 

The inner layer  - the epithelial layer - it absorbs and secretes mucus and digestive enzymes 

The middle layer -the lamina propria - it contains blood and lymph vessels 

The outer layer -the muscular mucosa -it contains smooth muscles which contracts and help in the breakdown of food 

STOMACH ANATOMICAL STRUCTURE 

Stomach - main regions 

• Cardiac 
• Fundus 
• Body 
• Antrum 
• Pylorus and pyloric sphincter 

Cardiac - it has a special cell known as foveolar cells it secretes mucus, its mucus contains water and glycoproteins.

Fundus and body - have 2 types of cells 
1 -parietal cells - secretes HCl 

2-chief cells - secretes pepsinogen - it helps in the digestion of protein 

Antrum - it has a special type of cells known as G cells it is also present in the duodenum and pancreas 

• The function of G cells is to stimulate parietal cells to secrete HCL and also stimulates the growth of glands.

Duodenum - it has Brunner's gland - it secretes mucus rich in bicarbonate ions this bicarbonate neutralizes the acid produced by the stomach.

• Prostaglandins are also stimulated when we eat something,it also secretes mucus and bicarbonates and vasodilates nearby blood vessels which promotes more blood flow and thus inhibits acid secretion.

Causes of peptic ulcer 

• H pylori bacteria 
• Nonsteroidal anti-inflammatory drug(NSAID) like ibuprofen,aspirin etc . NSAID inhibits cox enzyme this enzyme is responsible for the secretion of prostaglandins, this in turn maintains the HCl content but due to eating too much NSAID prostaglandins is inhibited and thus leads to ulcer 
• Smoking 
• Zollinger Elison syndrome - In this there is a tumor called Gastrinoma - it is a neuroendocrine tumor in the duodenal wall and pancreas, it secretes abnormal Gastrin and more HCL production and causes duodenal ulcers 

Pathophysiology of peptic ulcer 

• It is caused by H pylori bacteria 
• H pylori is a gram-negative bacteria 
• It has multiple flagella on its one end and no flagella on the other end 
• So it is motile 

Its pathogenesis occurs in 4 stages 

1 Urease activity 

2 Release of adhesins 

3 Release of genes

4 Inflammatory reaction 

• H pylori convert urea into ammonia and this reactivity forms a cloud around it and hides it from stomach HCL 
• It releases adhesins and gets burrowed below the mucus membrane and above the epithelial layer of the mucus membrane, it gets attached where the content is neutral 
• It causes chronic gastritis by releasing 2 genes 

1 CAG-A - it decreases cell proliferation and causes shrinking of cell 

2 VAC-A - it increases cell permeability due to which cell contents move outside it also causes shrinking of the cell.

After this, the infection causes 2 types of gastritis 

1 Antrum predominant pattern of gastritis 

2 Corpus predominant pattern of gastritis 

Antrum predominant pattern of gastritis 

• Due to the release of more stomach acid duodenum and liver pancreatic juice will not be able to neutralize it 
• Therefore it causes duodenal ulcer 
• Antrum has special cells known as D cells it releases somatostatin it has an inhibitory action on G cells 
• In duodenal ulcer D cell gets damaged due to which G cells are not inhibited and it stimulates more acid production 

Corpus predominant pattern of gastritis 

• It occurs due to stomach atrophy(size decreases) and Hypochlorhydria(less acid production)
• This causes the accumulation of more different types of bacteria and causes stomach ulcer 
• D cell is hyperactive and releases a large amount of somatostatin, G cell will be inhibited, and HCL production decreases.

Clinical features 

• Epigastrial pain( Right side of the abdomen)
• Nausea 
• Vomiting 
• Anemia due to internal bleeding 
• Diarrhea 
• In gastric ulcer weight loss is seen because pain increases while eating 
• In duodenal ulcer weight gain is seen and pain decrease while eating 

Some investigations to rule out the disease 

• Endoscopy 
• Serology 
• Histology 
• Rapid urease test 
• Photospectrometer 
• Fecal antigen test 
• C urea breath test 
•  Biopsy 

Medical management 

The aim of the treatment is to irradicate H pylori bacteria 

Avoid smoking and NSAID

1 Eradication therapy 

2 PPI( protein pump inhibitor) + Amoxicillin, Clarithromycin and metronidazole for 7 days 

3 Surgery is rarely used, it is basically used if there is gastric outflow obstruction 

Surgery can cause long term consequences like 

1 Dumping - There is rapid emptying of stomach contents it causes distension of the small intestine. This causes abdominal pain, sweating, increased heart rate 

2 Diarrhea just after eating food 

 

Complications of peptic ulcer 

1 Very deep ulcer - it causes internal bleeding and later it can lead to shock. In gastric ulcer, there is a chance of bleeding from the left gastric artery 

In duodenal ulcer, the gastroduodenal artery  can get damaged 

2 Perforation - In this gastric contents leaks into the peritoneal space 

It mostly occurs in anterior wall duodenal ulcer 

In this air started to collect under the diaphragm and irritates the phrenic nerve which in turn causes radiating pain and you will feel pain in your shoulder.

3 Gastric outlet obstruction - Long-standing duodenal ulcers causes edema and scarring and obstructs the normal passage causing gastric outlet obstruction.

This is the basic knowledge about peptic ulcers. 

Hope this article helps you in some way 

Be fit and healthy 

Thank you 

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