Lecture on Peptic Ulcer Disease

Introduction

• Peptic Ulcers: Sores in the stomach (gastric ulcers) or duodenum (duodenal ulcers).
• Prevalence: Duodenal ulcers are more common than gastric ulcers.

Gastrointestinal Tract and Stomach Anatomy

• Mucosa Layers:
  • Epithelial layer: Absorbs and secretes mucus/digestive enzymes.
  • Lamina propria: Contains blood/lymph vessels.
  • Muscularis mucosa: Smooth muscle aiding in food breakdown.
• Stomach Regions:
  • Cardia
  • Fundus
  • Body
  • Pyloric antrum
  • Pyloric sphincter: Closes while eating, retains food for digestion.

Gastric Glands and Secretions

• Cardia: Mainly foveolar cells secreting mucus.
• Fundus and Body:
  • Parietal cells: Secrete hydrochloric acid.
  • Chief cells: Secrete pepsinogen (protein digestion enzyme).
• Antrum: G cells secreting gastrin (also in duodenum and pancreas).

Gastric and Duodenal Defense Mechanisms

• Protective Mechanisms:
  • Thick mucus coating.
  • Bicarbonate ions neutralizing acid.
  • Blood flow delivering bicarbonate.
  • Prostaglandins: Stimulate mucus/bicarbonate secretion, vasodilation, inhibit acid secretion.

Causes of Peptic Ulcers

• H. pylori Bacteria: Gram-negative, colonizes gastric mucosa, releases adhesins/proteases causing mucosal damage.
• NSAIDs: Inhibit cyclooxygenase, decrease prostaglandins, making mucosa vulnerable.
• Zollinger Ellison Syndrome: Gastrinoma tumor secreting excess gastrin.

Characteristics and Complications of Ulcers

• Ulcer Features: Small, round "punched out" holes, clean base due to acid churning.
• Complications:
  • Bleeding: Ulcers eroding into blood vessels (e.g., left gastric artery, gastroduodenal artery).
  • Perforation: Ulcers through wall, contents spill into peritoneal space.
  • Gastric Outlet Obstruction: Edema/scarring preventing food passage, leading to nausea/vomiting.

Symptoms

• Main Symptom: Epigastric pain (aching/burning in upper abdomen).
• Other Symptoms: Bloating, belching, vomiting.
• Pain Characteristics:
  • Gastric ulcers: Pain increases with eating.
  • Duodenal ulcers: Pain decreases with eating.

Diagnosis and Treatment

• Diagnosis:
  • Upper endoscopy to view ulcer and biopsy to check for malignancy/H. pylori.
• Treatment:
  • Antibiotics and proton pump inhibitors for H. pylori.
  • Avoid NSAIDs, alcohol, tobacco, caffeine.
  • Surgery in extreme cases.