Chapter 7 pathophysiology of gastric ulcer development and healing. Ulcers are sores that are slow to heal or keep returning. Figure 4 shows an algorithm for guidelines for the evaluation and management of a patient who presents with dyspeptic or ulcerlike symptoms. Hence, the current recommendations for the drug treatment of peptic. Fortunately, integrative interventions including deglycyrrhizinated licorice dgl, zinccarnosine, and lactobacillus reuteri have powerful ulcerhealing.
Peptic ulcers are often caused by an overproduction of gastric acid. Despite advances in our understanding of venous ulcer formation and healing, ulcers still take an average of 6 months to heal, and ulcer recurrence rates at 5 years are 58%. The evolution of knowledge regarding etiopathogenesis of peptic acid disease from aciddriven disease to an infectious disease has opened up this topic for various studies to find the best possible options for management of this. A dull or burning pain in the stomach is the most common symptom. Peptic ulcer disease is when a defect develops in the mucous membrane of the stomach or duodenum, and this causes epigastric pain. Peptic ulcer disease usually occurs in the stomach and proximal duodenum. To improve the care of patients with venous ulcers, we need to further our understanding of the underlying pathologic events that lead to ulcer formation, prevent healing. The word poly means many and the word myalgia means muscle pain. Peptic ulcers are sores that develop in the lining of the stomach, lower esophagus, or small intestine. Gastric and duodenal ulcers usually cannot be differentiated based on history. No single cause has been found for ulcers, but various causes are listed. The aggressive role stems from its regulatory function in acid secretion, the defensive role is based on its trophic function. Many people who habitually take nsaids or aspirin have concurrent.
The interaction of these two factors in peptic ulcer disease is controversial. Pathophysiology of peptic ulcer download ebook pdf, epub. Peptic ulcer disease treatment johns hopkins medicine. Peptic ulcer disease and helicobacter pylori infection ncbi. Heterogeneity is the most important consideration in the pathophysiology of peptic ulcer disease. Clinical study of peptic ulcer disease peptic ulcer disease refers to painful sores or ulcers in the lining of the stomach or first part of the small intestine, called the duodenum. If you could see inside your gut, an ulcer appears like a little, red crater on the within lining of the gut. They newly began in around 53 million people in 2014. Gastric and duodenal ulcers are breaks in the gastric and duodenal mucosa.
Ppt peptic ulcer disease powerpoint presentation free. Peptic ulcer disease includes both gastric and duodenal ulcers which posed a major threat to the worlds population over the past two centuries with a high morbidity and mortality. Pathophysiology of diabetic ulcers can be seen in figure 2. The treatment of peptic ulcer disease pud is best understood against a background of pathogen esis and pathophysiology.
Peptic ulcers are present in around 4% of the population. Peptic ulcer disease refers to painful sores or ulcers in the lining of the stomach or the first part of the small intestine, the duodenum. The pathophysiological and pharmacological basis of peptic. Peptic ulcer is a hole or open sore in the lining of the stomach, duodenum beginning of the small intestine or oesophagus.
Peptic ulcer disease can involve the stomach or duodenum. It usually occurs in the stomach and proximal duodenum. Duodenal ulcers causes, symptoms, treatment and diet. Descriptive epidemiology, risk factors, management and prevention. A clinical case study duodenal ulcer perforation is the second most common abdominal emergency in our study. Eradication of hp infection alters the natural history of peptic ulcer disease. Peptic ulcer can occur in various parts of the gastrointestinal tract. Ulcerations in the git involve mucosal erosions of more than 0.
Peptic ulcer disease pud is a break in the inner lining of the stomach, the first part of the small intestine, or sometimes the lower esophagus. Gastrin can be regarded as an aggressive or a defensive factor in the pathogenesis of peptic ulcer disease. Theyre usually formed as a result of inflammation caused by the bacteria h. An ulcer happens where the lining of the gut is damaged and the underlying tissue is exposed. They affect different parts of the digestive tract, but both can cause pain and discomfort, and serious complications if. Peptic ulcer disease merck manuals professional edition. A circumscribed ulceration of the gastrointestinal mucosa occurring in areas exposed to acid and pepsin and most often caused by helicobacter pylori infection. Peptic ulcer is a break like a sore in the lining of the stomach or the upper part of the small intestine 1, with a diameter of at least 0. Pathophysiology of venous ulceration sciencedirect. Approximately 11%14% of men and 8%11% of women will develop peptic ulcer disease in their lifetime. Get a printable copy pdf file of the complete article 2. Polymyalgia rheumatica polymyalger rumahticker, or pmr, is a relatively common condition that causes stiffness and pain in muscles. Stomach ulcers are painful sores in the lining of the stomach. Full text full text is available as a scanned copy of the original print version.
The most common symptom of a peptic ulcer is stomach pain. Acute ulcers and erosions present clinically with gastroi factors concerned with mucosal defense are relatively more important than aggressive factors such as acid and pepsin. The first step in treatment is to exclude common possible causes, including. Types of diabetic foot ulcers according to edmon diabetic foot ulcers are divided into 2 groups, namely. Gastric and duodenal ulcers are types of peptic ulcer. They can take many forms and can appear both on the inside and the outside of your body. The pain can often be relieved by eating certain foods that buffer stomach acid or by taking an acidreducing medication, but then it may come back.
Clinical study of peptic ulcer disease allied academies. Since the advent of effec tive medical therapy with the introduction in 1976 of cimetidine, the first histamine h2 receptor an tagonist, there have been remarkable advances in our understanding of how ulcers develop. It can start at any age from 50, but mainly affects people over the age of 70. Diagnosis and treatment of peptic ulcer disease and h. Peptic ulcer are sores in the lining of the esophagus, stomach or duodenum the main symptom of a stomach or duodenal ulcer is upper abdominal pain, which can be dull, sharp, or burning a hungerlike feeling. A peptic ulcer is an ulcer triggered by stomach acid. This protocol may be used by general practitioners, family doctors, and nurses. An overview of history, pathogenesis and treatment of.
Ulcers generally range between 3 mm and several centimeters in diameter. Pathophysiology of peptic ulcer disease springerlink. Esophageal ulcer open sores or lesions in the lining of esophagus mostly occur in the lower end of esophagus causes associated with bad case of. The pathophysiology of gastric cancer the pathophysiology of gastric cancerthe pathophysiology of gastric precancerous lesions the incidence of gastric cancer rarely produced directly from the normal gastric mucosa epithelium, and most have occurred in the gastric epithelial abnormality or disease based on the produce. Both gastric and duodenal ulcers relate to the corrosive action of pepsin and hydrochloric acid on the mucosa of the upper gastrointestinal tract. Stabilise according to sepsis guidelines, but be aware to minimise delay to surgery. Duodenal and gastric ulcers are typically called peptic ulcers. Less commonly, a peptic ulcer may develop just above the stomach in the esophagusthe organ that connects the. This site is like a library, use search box in the widget to get ebook that you want. Stomach acid makes the pain worse, as does having an empty stomach. Although pud is most commonly caused by helicobacter pylori infection or use of nonsteroidal antiinflammatory drugs nsaids, other diagnoses should be considered table 1.
Classically, gastric ulcer pain is aggravated by meals, whereas the pain of duodenal ulcers is relieved by meals. Chronic, usually solitary, due to acidpeptic juices. The occurrence of peptic ulcer disease is similar in men and women. Bloating and burping are not symptoms of peptic ulcer, and vomiting, poor appetite, and nausea are uncommon symptoms of peptic ulcer. People who take nsaids such as aspirin and ibuprofen longterm or are infected with the bacteria h. Historically, our understanding of the pathophysiology of peptic ulcer disease focused on abnormalities in. Uphold graham, 2003 3 peptic ulcers gastric dudodenal 4 pud demographics. Patients may describe the pain of peptic ulcer as burning or gnawing, or as hunger pains slowly building up for 12 hours, then gradually decreasing. Peptic ulcer disease symptoms, treatment, pathophysiology. It extends into the muscularis propria layer of the gastric epithelium. Peptic ulcer is an erosion of the gastric mucosa resulting from the digestive action of hydrochloric acid and pepsin. A free powerpoint ppt presentation displayed as a flash slide show on id. Frequencies 10% of the world population 611% in different sources men. The mechanism of occurrence of pud results from an.
Ulcers are caused by an infection of a bacterium known as helicobacter pylori or h. Protocol for diagnosis and treatment of peptic ulcer in. The predominant causes in the united states are infection with helicobacter pylori and use of nonsteroidal anti. Etiology, pathophysiology, diagnosis and management of. Understanding the pathophysiology and best treatment strategies for nonnsaid, nonh. Successful eradication reduces pud recurrence rate from 90% to causes h.
Mucosal injury due to helicobacter pylori infection, nsaid use, zollingerellison syndrome multiple peptic ulcerations in stomach, duodenum and jejunum due to excess gastrin secretion by a tumor. Peptic ulcer disease or simply peptic ulcer is the presence of ulcerations in the gastrointestinal tract, which is characterized by being acidic and extremely painful. Symptoms of peptic ulcer disease are variable and may include abdominal pain, nausea, vomiting, weight loss and bleeding or perforation with complicated disease. A peptic ulcer is a sore in the lining of the stomach, where it is called a gastric ulcer, or the first part of the small intestine, called a duodenal ulcer. The pathophysiology of peptic ulcer disease springerlink. Pdf on nov 5, 2011, jianyuan chai and others published peptic ulcer disease find, read and cite all the research you need on.
Also, duodenal ulcers are more common in men than in the woman. Click download or read online button to get pathophysiology of peptic ulcer book now. After invention of the h2 blockers and proton pump inhibitors the role of elective surgery for duodenal ulcer has been drastically decreasing, but the incidence of perforation is not much changing. Nsai, aspirin, cortisone and cytotoxic drugs cigarette smoking. Polymyalgia rheumatica pmr causes, symptoms, treatments. Links to pubmed are also available for selected references. A peptic ulcer stomach ulcer is a sore on the lining of your stomach or duodenum. Many treatment options focus on reducing or suppressing gastric acid production. An idiopathic peptic ulcer is defined as an ulcer with unknown cause or an ulcer that appears to arise spontaneously. Identifying the risk factors and mechanisms that lead to the development of pud helps to understand the. Peptic ulcer disease pud is characterized by discontinuation in the inner lining of the gastrointestinal gi tract because of gastric acid secretion or pepsin. The most common peptic ulcer symptom is burning stomach pain. Identifying the risk factors and mechanisms that lead to the development of pud helps to understand the approach behind diagnostic and treatment strategies. Perforated peptic ulcer is a surgical emergency and is associated with shortterm.