Peptic ulcer

Contents �

• Peptic ulcer
• Pathophysiology of peptic ulcer
• Symptoms of peptic ulcer
• Anti-ulcer drugs

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Objectives ��

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

• Explain the pathophysiology of peptic ulcer
• Describe the symptoms
• Classify Antiulcer drug

Peptic ulcer

Introduction

• Peptic ulcer very common disease of alimentary tract
• Peptic Ulcer(PU) is an ulcer of the GIT at an area exposed to the acid pepsin mixture (APM),i.e.the mucosa of the GIT
• This area is digested by pepsin (peptic digestion), hence the name
• A peptic ulcer is an ulcer (defined as mucosal erosions) of an area of the gastrointestinal tract that is usually exposed to the aggressive action of acid-peptic juices

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Introduction cont…

• It causes inflammatory injuries in either the gastric or duodenal mucosa, with extension beyond the submucosa into the muscularis mucosa
• A peptic ulcer of the stomach is called a gastric ulcer & ulcer of duodenum is called a duodenal ulcer and of the esophagus is called an esophageal ulcer

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Sign & Symptoms

• Dyspepsia (Indigestion)
• Abdominal pain
• Heart burn
• Bloating (swollen state)
• Nausea
• Anorexia
• Weight loss
• Melena (Black vomit)

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Pathophysiology of PUD

Normal ��

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Increased Attack� Hyperacidity��

Weak defense� Helicobacter pylori� Stress, drugs, smoking

HCO3

Ischemia

NSAIDs

Mucus

Blood flow

Growth factor

PGs

Cell renewal

H+

Smoking

Bile acid

Pepsin

Ethanol

Protective

Damaging

Hypoxia

H.Pylori

©M. S. Ramaiah University of Applied Sciences

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Pathophysiology cont…

• Gastric and duodenal ulcers usually cannot be differentiated based on history alone, although some findings may be suggestive.
• Epigastric pain is the most common symptom of both gastric and duodenal ulcers.
• It is characterized by a gnawing or burning sensation and occurs after meals—classically, shortly after meals with gastric ulcer and 2-3 hours afterward with duodenal ulcer.

Pathophysiology cont…

• Under normal conditions, a physiologic balance exists between gastric acid secretion and gastroduodenal mucosal defense.
• Mucosal injury and, thus, peptic ulcer occur when the balance between the aggressive factors and the defensive mechanisms is disrupted.

Pathophysiology cont…

• Aggressive factors, such as nonsteroidal anti-inflammatory drugs (NSAIDs), H pylori infection, alcohol, bile salts, acid and pepsin can alter the mucosal defense by allowing back diffusion of hydrogen ions and subsequent epithelial cell injury
• The defensive mechanisms include tight intercellular junctions, mucus, mucosal blood flow, cellular restitution, and epithelial renewal

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Secretion of HCl by gastric parietal cell and its regulation

Diagnostic tests

• Barium swallow: You drink a thick white liquid (barium) that coats your upper gastrointestinal tract and helps your doctor see your stomach and small intestine on X-rays
• Endoscopy (EGD): A thin, lighted tube is inserted through your mouth and into the stomach and the first part of the small intestine
• This test is used to look for ulcers, bleeding and any tissue that looks abnormal

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Diagnostic tests cont..

• Endoscopic biopsy: A piece of stomach tissue is removed so it can be analyzed in a lab.

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Classification of antiulcer drugs

1. Reduction of gastric acid secretion

(a) H2 antihistamines: Cimetidine, Ranitidine,Famotidine, Roxatidine

(b) Proton pump inhibitors: Omeprazole, Lansoprazole, Pantoprazole, Rabeprazole,Esomeprazole

(c) Anticholinergics: Pirenzepine, Propantheline,Oxyphenonium

(d) Prostaglandin analogue: Misoprostol

Antiulcer drugs cont…

2. Neutralization of gastric acid (Antacids)

(a) Systemic: Sodium bicarbonate, Sodium citrate

(b) Nonsystemic: Magnesium hydroxide, Magnesim trisilicate, Aluminium hydroxide gel, Magaldrate, Calcium carbonate

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Antiulcer drugs cont…

3. Ulcer protectives: Sucralfate, Colloidal bismuth subcitrate (CBS)

4. Anti-H. pylori drugs: Amoxicillin, Clarithromycin,Metronidazole, Tinidazole, Tetracycline

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Summary

• Peptic Ulcer(PU) is an ulcer of the GIT at an area exposed to the acid pepsin mixture (APM),i.e.the mucosa of the GIT
• The pathophysiological structure shows aggressors like increased acid and pepsin, an impaired defence system of the mucosa.
• Acute ulcers and erosions present clinically with gastrointestinal bleeding or perforation

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