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Peptic ulcer disease

life science Maturity 11-13 Next article →

Peptic ulcer disease is a medical condition involving damage to the gastric mucosa. This is the inner lining of the stomach. Ulcers can also form in the lower esophagus or the duodenum. The duodenum is the first part of the small intestine.

Peptic ulcer
Peptic ulcer

When an ulcer is in the stomach, it is a gastric ulcer. When it is in the duodenum, it is a duodenal ulcer. These sores are significant because they can lead to serious health complications. About 10% of people will develop a peptic ulcer during their lives. At any given time, ulcers are present in roughly 4% of the population.

Peptic ulcer disease world map-Deaths per million persons-WHO2012
Peptic ulcer disease world map-Deaths per million persons-WHO2012

The mechanism of an ulcer involves the breakdown of the protective mucosal layer. The stomach uses mucus and bicarbonate to shield itself from strong acid. One major cause is infection by the bacterium Helicobacter pylori. This bacterium secretes an enzyme called urease to create an alkaline environment. This helps the germ survive in the acidic stomach. The bacteria use proteins called adhesins to attach to the stomach lining. They also release virulence factors like CagA and PicB. These factors cause inflammation in the mucosa.

Erosive gastric ulcer
Erosive gastric ulcer

This inflammation can change how much acid the stomach produces. In some cases, it leads to a reduction in acid, causing gastric ulcers. In other cases, it increases acid production, leading to duodenal ulcers.

Another common cause involves non-steroidal anti-inflammatory drugs, or NSAIDs. These include medicines like aspirin. The stomach protects itself using prostaglandins. These are substances that help stimulate mucus secretion. NSAIDs work by inhibiting an enzyme called cyclooxygenase, or COX-1. This enzyme is essential for making prostaglandins. When COX-1 is blocked, mucus secretion decreases. This reduces the integrity of the stomach lining. NSAID-related ulcers often dig deeper into the tissue more quickly than other types. This can lead to complications even if the person does not feel much pain.

Deep gastric ulcer
Deep gastric ulcer

Symptoms often depend on the location of the ulcer. A duodenal ulcer typically causes pain about three hours after eating. This pain often wakes people up at night. Interestingly, eating a meal can sometimes relieve this pain. A gastric ulcer behaves differently. The pain from a gastric ulcer may worsen when a person eats. This happens because acid production increases when food enters the stomach. Most people describe the sensation as a burning or dull ache. Other symptoms include nausea, vomiting, or weight loss. About one-third of older people with ulcers show no symptoms at all.

Duodenal ulcer01
Duodenal ulcer01

Complications from peptic ulcers can be severe. The most common complication is gastrointestinal bleeding. This occurs in as many as 15% of cases. Sudden, large bleeding events can be life-threatening. Another serious issue is perforation. This is when the ulcer creates a hole in the wall of the digestive tract. If a gastric ulcer perforates, it can cause acute peritonitis. This is an inflammation of the abdominal cavity. Perforation requires immediate surgery.

GU with clip
GU with clip

Another complication is gastric outlet obstruction. This is a narrowing of the canal that leads out of the stomach. It is caused by swelling or scarring and can lead to severe vomiting.

Medical understanding of ulcers has changed greatly over time. For nearly 100 years, doctors believed stress and spicy food caused ulcers. The first description of a perforated ulcer was recorded in 1670 regarding Princess Henrietta of England. However, the true causes were found much later. Barry Marshall and Robin Warren identified H. pylori as a cause in the late 20th century. Their discovery changed how we treat the disease. They were awarded the Nobel Prize in 2005 for this work. In 2015, new ulcers were found in approximately 87.4 million people worldwide.

peptic ulcer disease world map - DALY - WHO2004
peptic ulcer disease world map - DALY - WHO2004

Doctors use several methods to diagnose and treat the disease. They may use an endoscopy to look inside the stomach. An endoscopy is a procedure where a tool is used to view the lining. They can also use a barium swallow for imaging. To find H. pylori, doctors may use a urea breath test or a stool test. Treatment often involves medications to decrease stomach acid. These are called proton pump inhibitors (PPIs) or H2 blockers. For H. pylori infections, doctors prescribe a combination of antibiotics like amoxicillin and clarithromycin.

Antisectetory drugs
Antisectetory drugs

Patients are also advised to stop smoking and avoid NSAIDs to help the ulcers heal.

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🖼️ Images & Media (13)
File:Duodenal ulcer01.jpg
Duodenal ulcer01.jpg
File:Deep gastric ulcer.png
Deep gastric ulcer.png
File:Gastric ulcer 2.jpg
Gastric ulcer 2.jpg
File:Gastric ulcer 3.jpg
Gastric ulcer 3.jpg
File:Adenocarcinoma of the stomach.jpg
Adenocarcinoma of the stomach.jpg
File:Peptic ulcer.svg
Peptic ulcer.svg
File:Benign gastric ulcer 1.jpg
Benign gastric ulcer 1.jpg
File:Erosive gastric ulcer.jpg
Erosive gastric ulcer.jpg
File:Gastric MALT lymphoma 2.jpg
Gastric MALT lymphoma 2.jpg
File:Antisectetory drugs.jpg
Antisectetory drugs.jpg
File:GU with clip.jpg
GU with clip.jpg
File:Peptic ulcer disease world map-Deaths per million persons-WHO2012.svg
Peptic ulcer disease world map-Deaths per...

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