Gastric ulcer

1. Dr.W.C. Lwabby (MMed, MD)
Lecturer Int. Med.Dept
Thursday, February 1, 2024 1

2.  To define peptic ulcer disease(PUD)
 To describe the pathophysiology of PUD
 To discuss the diagnosis of PUD
 To describe the treatment of PUD
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4. Thursday, February 1, 2024 4

5. 1. CO2 and Cl- diffuse from the
blood into the stomach cell.
2. CO2 combines with H2O
to form H2CO3.
3. H2CO3 dissociates into
bicarbonate (HCO3-) and H+.
4. H+ combines with Cl- in duct
of gastric gland to form HCl-.
5. An ATP pump is necessary to
pump the HCl- into the duct
since the concentration of
HCl- is about a million times
more concentrated in the
duct than in the cytosol of the
cell.
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6.  The inside of the stomach is bathed in about 2L of gastric juice
daily.
 Gastric juice is composed of;
 Digestive enzymes & Concentrated hydrochloric acid
▪ which can readily tear apart the toughest food or microorganism
 The gastroduodenal mucosal integrity is determined by;
 Protective (defensive)
 Damaging (aggressive) factors
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 The Defensive Forces
 Bicarbonate
 Mucus layer
 Mucosal blood flow
 Prostaglandins
 Growth factors
 The Aggressive Forces
 Helicobacter pylori
 HCl acid
 Pepsins
 NSAIDs
 Bile acids
 Ischemia and hypoxia.
 Smoking and alcohol
When the aggressive factors increase or the defensive factors decrease,
Mucosal damage will result, leading to erosions & ulcerations.

8. Definition;
 Peptic Ulcer
 An ulcer of the alimentary tract mucosa, usually in the;
▪ Stomach
▪ Duodenum
▪ Lower esophagus( rarely),
▪ where the mucosa is exposed to the acid gastric secretion
 It has to be deep enough to penetrate the muscularis mucosa
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9. Thursday, February 1, 2024
Peptic Ulcer Disease

10.  A peptic ulcer is a mucosal break,
 3mm or greater in size with depth.
 Two major variants in peptic ulcers are commonly encountered in
the clinical practice:
 Duodenal Ulcer (DU)
 Gastric Ulcer (GU)
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11. DU results from increased acid load to the duodenum due to:
 Increased acid secretion because of:
 Increased parietal cell mass
 Increased gastrin secretion,
(e.g. Zollinger-Ellison syndrome, alcohol & spicy food)
 Decreased inhibition of acid secretion,
 possibly by H. pylori damaging somatostatin-producing cells in the
antrum
 Smoking impairing gastric mucosal healing
 Genetic susceptibility may play a role
 HCO3 secretion is decreased in the duodenum by H. pylori inflammation
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12. GU results from the break down of gastric mucosa:
 Associated with gastritis affecting the body & the antrum
 The local epithelial damage which occurs because of;
 Cytokines released from H. pylori
 Abnormal mucus production
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13.  The two most common causes of PUD are:
▪ Helicobacter pylori infection ( 70-80%)
▪ Non-steroidal anti-inflammatory drugs (NSAIDS)
 Other uncommon causes include:
▪ Gastrinoma (Gastrin secreting tumor)
▪ Stress ulceration (trauma, burns, critical illness)
▪ Vascular insufficiency
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14. H. pylori;
 Is Gram-negative and spiral
 Has multiple flagella at one
end,
 which make it motile,
 allowing it to live deep beneath
the mucus layer where the pH is
close to neutral
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15.  Any acidity is buffered by;
 Organism's production urease
enzyme,
 which catalyzes production of
ammonia (NH3) from urea &
raises the pH
 The bacterium stimulates
chronic gastritis by;
 provoking a local inflammatory
response.
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17. Interesting, right?
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