This document discusses peptic ulcers, including their etiology, pathogenesis, symptoms, diagnosis, and conclusions. Peptic ulcers are erosions in the stomach or duodenum caused by an imbalance between aggressive factors like acid and pepsin secretion and defensive mucosal factors. Key causes of this imbalance are Helicobacter pylori infection, NSAID use, smoking, stress, and genetic conditions. Symptoms vary depending on the location of the ulcer but can include pain, nausea, vomiting, weight loss, and bleeding. Diagnosis is typically via endoscopy or barium imaging tests. The conclusion recommends avoiding stress and contamination to help prevent ulcers.

1. PATHOPHYSIOLOGY
PEPTIC ULCERS
Nem Kumar Jain
M.S. (Pharm.) Pharmacology & Toxicology
Assistant Professor
School of Pharmacy
ITM University Gwalior

2. N- nicotinic receptors
M- muscarinic receptors
GRP- gastrin related peptide
Ach- acetyl choline
CCK2 cholecystokinin
Hist- histamine
ECL cell- enterochromaffine
cells
PGE2- Prostaglandin E2
EP3- prostaglandin E
receptor 3
H2- Histamin receptor type 2
PHYSIOLOGY OF GASTRIC ACID SECRETION

3. PEPTIC ULCER
 An Ulcer is …
 Erosion in the mucosal lining of the stomach or the
duodenum.
 Ulcers damage the mucosa of the alimentary tract,
which extends through the muscularis mucosa into the
sub mucosa or deeper.
 Peptic Ulcers are the areas of degeneration and
necrosis of GIT mucosa exposed to acid-peptin
secretion

4. Most Commonly (98-99% cases)
Ulcers that form in the stomach are called Gastric ulcers;
in the duodenum, they are called Duodenal ulcers. Both
types are referred to as Peptic ulcers.
Occurrence Ratio-
Duodenal: Gastric= 4:1
Acute Ulcers (Stress Ulcers)
-Gastric Ulcer
Chronic Ulcers:
- Gastric & Duodenal
More common in males
than in Females (4:1)

5. PEPTIC ULCER

6. ETIO-PATHOGENESIS OF PEPTIC ULCER DISEASE
IMBALANCE:
 Acid
 Pepsin
 Helicobacter pylori
 NSAIDS
 Tobacco
 Smoking
 Psychological Stress
 Hypergastrinemia
(ZES)*
 Spicy food, Coffee
 Prostaglandins
 Mucosal blood flow
 Mucous gel layer
 HCO3
 Epithelial junctions
 Regeneration of the
epithelial layer
 Epidermal growth
factor
AGGRESSIVE FACTORS DEFENSIVE FACTORS
Disruption of Mucosal Lining
Exposure to Gastric acid and pepsin secretion
H. Pylori infection
 * ZES- zollinger ellison syndrom

7. HELICOBACTER PYLORI INDUCED
 1981 - Robin Warren,
M.D., an Australian
pathologist, discovered
numerous bacteria
living in tissue taken
during a stomach
biopsy.
 Spiral urease-
producing, Gram-
negative bacteria
always accompanied
changes in the stomach
lining

8. HELICOBACTER PYLORI
 Gram negative, Spiral bacilli ,Spirochetes
 Do not invade cells – only mucous lining
 Breakdown urea – ammonia and CO2
 Break down mucosal defense: Urease, Protease, catalase,
Phospholipase, Cytotoxin associated gene protein (CagA),
Vacuolating cytotoxin (VacA)
 Chronic Superficial inflammation: Elaboration of IL-1, IL-6,
IL-8, TNF alpha by infected mucus cells
 IL-8 acts as chemoattract for neutrophils and
macrophages---- Acute inflammation (Gastritis)
Test for diagnosing H.pylori
Breath test :by measuring the amount of co2 in exhaled
breath.
Blood test: by identifying H.pylori antibodies by ELISA test.
Stool test :stool sample tested with H.pylori antigen.

9. HOW H. PYLORI SURVIVES THE ACIDITY AND
CAUSE ULCERS

10. NSAID INDUCED ULCERS
 Most commonly used Analgesic and anti-
inflammatory medications: ibuprofen, diclofenac,
aspirin etc.
 Linked to direct toxicity, endothelial damage and
epithelial injury
 NSAIDS Inhibits production of Cytoprotective
Prostaglandins (PGE2 & PGI2) (Inhibits acid
secretion, promotes mucus as well as bicarbonate
ions)
 Disrupt mucosal barrier
 Chronic consumption affects both duodenal and
gastric mucosa.

11. SYMPTOMS
 Food-Pain pattern
 No night Pain
 Nausea or vomiting
 Haematemesis more
common
 Unexplained weight loss
 Anorexia
 Abdominal fullness
 Pain-food-relief pattern
 Pain Starts 2/3 hours after
meals, or in the middle of the
night
 No Vomiting
 Melaena common than
Haematemesis
 Indigestion
 Feeling very hungry 1 to 3
hours after eating
 Mild nausea
Duodenal Ulcers Gastric Ulcers

12. DIAGNOSIS
 Endoscopy:
Flexible tube fitted with
camera is threaded down the
esophagus in to stomach to
see the ulcer by physician
 Barium meal:
Barium liquid is drunk
making ulcer visible on X-ray

13. CONCLUSION

14.  Avoid stress
 Avoid contamination