– Superficial erosion
– Minimal erosion
– Muscular wall erosion with formation of fibrous
– Present continuously for many months or
• Peptic ulcers are the end result of an imbalance
between digestive fluids in the stomach and
• Ulcers can be caused by:
– Infection with a type of bacteria called Helicobacter pylori
– Use of painkillers called nonsteroidal anti-inflammatory
drugs (NSAIDs), such as aspirin, ibuprofen
– Excess acid production from gastrinomas, tumors
producing gastrin which act on the acid producing cells of
the stomach that increases acid output (Zollinger-Ellison
• (Zollinger-Ellison syndrome) is caused by a
gastrin-secreting tumor of the pancreas that
stimulates the acid-secreting cells of the
stomach to maximal
activity, with consequent
• Those who are infected with the H. pylori bacterium
• Take NSAIDs such as aspirin, ibuprofen
• Have a family history of ulcers
• Drink alcohol regularly
• Are 50 years old or older
• Two mechanisms
– Mucus forms a layer that entraps or slows
diffusion of hydrogen ions(HCl) across mucosal
– Bicarbonate is secreted
• Neutralizes HCl acid in lumen of GI tract
• An ulcer may or may not have symptoms. When symptoms occur,
they may include:
• A burning pain in the middle or upper stomach between meals or
• Nausea or vomiting
• In severe cases, symptoms can include:
• Dark or black stool (due to bleeding)
• Vomiting blood (that can look like "coffee-grounds")
• Weight loss
• Severe pain in the mid to upper abdomen
• Tests for H. pylori
– Noninvasive tests
• Serum or whole blood antibody tests
–Immunoglobin G (IgG)
• Urea breath test
– Invasive tests
• Biopsy of stomach
– Determines degree of ulcer
healing after treatment
– Tissue specimens can be
obtained to identify H. pylori
and to rule out gastric cancer
How Are Ulcers Treated?
• Lifestyle Changes to Treat an Ulcer
To treat an ulcer, first eliminate substances that
can be causing the ulcers. If you smoke or
drink alcohol, stop. If the ulcer is believed to
be caused by the use of NSAIDs, they need to
• Ulcer Medications
Proton pump inhibitors (PPI). Proton pump
medications reduce acid levels and allow the
ulcer to heal
Antibiotics. If you have H. pylori infection, then
antibiotics are used.
• Upper Endoscopy: Some bleeding ulcers can
be treated through an endoscope.
• Surgery. Sometimes an operation is needed if
the ulcer has created a hole in the wall of the
stomach or if there is serious bleeding that
can't be controlled with an endoscope
• No. In fact, milk can make an ulcer worse.
Milk provides brief relief of ulcer pain because
it coats the stomach lining. But milk can also
stimulate the stomach to produce more acid
and digestive juices, which can aggravate
• Achlorhydria or hypochlorhydria refers to
states where the production of gastric acid in
the stomach is absent or low, respectively.
• Because of low or absent HCl, protein
digestion is impaired because HCl is required
for the activation of pepsinogen into pepsin.
• Bacterial growth in stomach(HCl have
• Autoimmune disorders where there is antibody
production against parietal cells which normally
produce gastric acid.
• The use of antacids or drugs that decrease gastric acid
production (such as H2-receptor antagonists) or
transport (such as proton pump inhibitors)
• atrophic gastritis
• tomach cancer.
• Radiation therapy involving the stomach.
A particular slide catching your eye?
Clipping is a handy way to collect important slides you want to go back to later.