Peptic Ulcer Disease Pathophysiology

Peptic ulcer

(The word peptic mean digestion and ulcer is open sore, wound)

Peptic ulcer is define as the erosion of the mucosal layer of the stomach. An ulcer is a wound a sore have clean size and shape

The ulcer in stomach is called the gastric ulcer, in esophagus- esophageal ulcer and at duodenal area is called a duodenal ulcer.

The most common cause of the peptic ulcer is more acid formation in the stomach. The acid cause irritation of the mucosal barrier lead to develop ulcer on the normal mucosal structure.

The ulcer develops more prominently in males then women.

CAUSES & RISK FACTORS

The peptic ulcer occur when the mucosal layer of stomach is injured by rough food particles and acid that is present in the stomach.

The ulcers develop in the stomach can penetrate the mucosal layer and destroy the nearby organs of the body.

The underlying cause of the peptic ulcer is high HCL fluid that irritates gastric mucosa. 

• Infection 

Any bacterial infection present in the stomach increases metabolic and chemical processes that elevates the acid levels in the stomach.

• Increased HCL production 

High amount of HCL fluid irritates mucosal layer and it results in gastric ulcer. 

• Excess intake of food items such as tea, coffe

Tea and coffe taken excessively irritate the stomach mucosal lining constanty breaking normal mucosal barrier.

• Low quality mucosa production 

Low quality mucosa get damaged by HCL and harsh food particles. It can occur due to GI disease and poor cell function.

• Iatrogenic effect 

Iatrogenic means drug induced. Certain medications such as NSAID, sedative affect gastric mucosal production. Long term use of drug result in ulcer formation.

• Alcohol

• Smoking 

• Drug abuse

• Tobacco chewing 

Symptoms

Gastric ulcer (peptic ulcer) is develop in the stomach mucosal layer. This result in following symptoms:-

• Feeling of fullnes without the food 

It is common sign if peptic/ gastric ulcer. Petient feel fullness of stomach without food. 

• Frequent pain in the abdomen 

Ulcer causes cramps in abdomin resulting in frequent abdominal pain.

• Loss of appetite 

Ulcers ater metabolism and normal function of abdomen. It cause decrease appetite of person.

• Nausea & vomiting 

Continuous stimulation to gastric layer provoke nausea and vomiting. 

• Blood in stool 

Severe ulcers lead to bleed in abdomin. It result in blood in stools.

• Mild Chest pain 

The early stage peptic ulcer symptoms are mentioned above.

When the ulcer become intense (chronic peptic ulcer) following symptoms are seen in the person:-

• Severe abdominal pain

Ulcer causes stimulation of gastric nerves that causes severe pain in abdomin. 

• Blood in stool

• Severe chest pain

Pathophysiology of the peptic ulcer

Peptic ulcer pathophysiology 

The pathophysiology of the peptic ulcer is starts with etiological damage to the stomach mucosal lining.

The causative factors is the acid juices, infection, gi irritants.  Thereafter, the causative agents will irritates the mucosal barrier of the stomach.

The continuous errosion and irritation to mucosa cells injured the cells of mucosal layer. It then decreased the quality of the new mucosal production, impact on failure to act as strong barrier.

There will be long term inflammation of the mucosal cells and tissues lead to the complete damage to the mucosal area, the ulcer is seen after that.

Diagnostic criteria of peptic ulcer

The peptic ulcer can be diagnosed by the symptoms explained by the patient. The test done to diagnosed peptic ulcer:-

• Blood test

The blood test is use to diagnose bacteria present in the blood. 

• Endoscopy 

The endoscopy is the procedure in which the internal abdominal structure is visualized by the endoscope. Then the ulcer is visualized for size, growth and how much area is actually damaged. 

• Sputum culture 

The sputum culture is done to diagnose bacterial invasion.

Medicines for the peptic ulcer

The peptic ulcer is treat with antibiotic therapy, commonly given medicine's are antihistamine, antacid & mucolytic agents.

• Antacids

Antacid is given to neutralize the acids in the stomach, aspirin is given. It reduces the level of acid in body.

• Proton pump inhibitor

It reduces ulcer by inhibiting the productiin of acid. Medicines are omeprazole, pantaprazole, esomeprazole. 

• Antibiotics

The antibiotic drug decrease bacterial growth and invasiveness. Common medicine use are amoxicillin, tetracycline.

• NSAID

The nsaid decrease the irritation of mucosal lining by reducing the inflammation over the injured cells.

• Cytoprotective agents

These medicines protect & helps in developing new cells. The cytoprotective mean agent protecting the mucosal cells.

Surgical treatment for peptic ulcer 

• Pyloroplasty

The pylorus section is located in the distal area of the stomach i.e at the duodenal area. In this the shape of the pylorus is widened so as to increase food output. Then, the food is passed in early period & less acid is produced in the body.

• Vagotomy

In vagotomy, the vagus nerve is cut and remove from the stomach. The vagus nerve stimulate and responsible for the acid production, when the nerve is removed from the body then the acid production is decrease in the stomach. 

• Gastrectomy

Gastrectomy is the surgical removal of the stomach completely or a part of the stomach is removed. This is done in cases of complete damage of the stomach & that is damaging other tissues and organs.