Peptic ulcer ,symptoms , causes, treatment

 Introduction

Peptic Ulcer is a lesion in the lining (mucosa) of the digestive tract, typically in the stomach or duodenum, caused by the digestive action of pepsin and stomach   acid. Lesion may subsequently occur into the lamina and sub mucosa to cause bleeding. Most of peptic ulcer occurs either in the duodenum, or in the stomach. Ulcer may also occur in the lower esophagus due to reflexing of gastric content. Rarely in certain areas of the small intestine

Definition: 

Ulceration of mucosa which is exposed to acid peptic juice. Different sites can be affected duodenum, stomach, Jejunum edsophagus, and meckel’s diverticulum (contains ectopic gastric tissue) 

Pathophysiology :

 Under normal conditions, a physiologic balance exists between gastric acid secretion and gastro-duodenal mucosal defense. Mucosal injury and, thus, peptic ulcer occur when the balance between the aggressive factors and the defensive mechanisms is disrupted. Aggressive factors, such as 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. 

Etiology and risk factors: 

*It occurs when stomach acid penetrates the stomach and/or duodenal lining. It’s a mix of :  

• Hyperacidity: duodenal ulcer.  
• Decreased mucosal resistance: gastric ulcer.  

*Helicobacter  pylori: 

• Responsible for the majority of peptic ulcer (90% of DU , 70% of GU ). It is a gram -ve spiral bacillus transmitted by feco-oral or through mouth to mouth such as kissing. Many people have H.pylori infection, but not everyone who has an infection will develop a peptic ulcer. Pathogenesis of H.pylori :  

1.       / Decrease gastrin release.                
2.       /  Increase somatostatin.               
3.       /  Produce cytotoxins causing mucosal inflammation.  

*Non-steroidal anti-inflammatory drugs (NSAIDs):  

• NSAIDs act by inhibiting cyclo-oxygenase enzyme (COX) leading to decrease prostaglandin lead to mucosal erosions & ulceration. 
• Notice that prostaglandin play a big role in gastric protection

Types: 

1. Gastric Peptic Ulcer: means occurrence of ulcer in stomach.  
2. Duodenal Peptic Ulcer: Occurrence of ulcer in the duodenum  

Clinical picture:    

• Symptom :    Epigastric pain   

• Signs:   may be negative 

• Localized tenderness at the site of ulcer (severe tender suggests a perforation) 

• Physical examination is critically important for discovering evidence of ulcer complications.  

Management :

          1/  Life Style Modification 
      2/   Hypo secretory Drug Therapy 
          3/   H. Pylori Eradication Therapy 
          4/  Treatment complications 
          5/  Surgery