Pathophysiology of Peptic Ulcer PDF / PPT

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Pathophysiology of
Peptic Ulcer 1


• Peptic ulcer

• Pathophysiology of peptic ulcer

• Symptoms of peptic ulcer

• Anti-ulcer drugs 2


At the end of this lecture, student will be able to

• Explain the pathophysiology of peptic ulcer

• Describe the symptoms

• Classify Antiulcer drug 3

Peptic ulcer 4


• Peptic ulcer very common disease of alimentary tract

• Peptic Ulcer(PU) is an ulcer of the GIT at an area exposed to the

acid pepsin mixture (APM),i.e.the mucosa of the GIT

• This area is digested by pepsin (peptic digestion), hence the name

• A peptic ulcer is an ulcer (defined as mucosal erosions) of an area

of the gastrointestinal tract that is usually exposed to the

aggressive action of acid-peptic juices 5

Introduction cont…

• It causes inflammatory injuries in either the gastric or duodenal

mucosa, with extension beyond the submucosa into the muscularis


• A peptic ulcer of the stomach is called a gastric ulcer & ulcer of

duodenum is called a duodenal ulcer and of the esophagus is called

an esophageal ulcer 6 7

Sign & Symptoms

• Dyspepsia (Indigestion)

• Abdominal pain

• Heart burn

• Bloating (swollen state)

• Nausea

• Anorexia

• Weight loss

• Melena (Black vomit) 8

Pathophysiology of PUD


Increased Attack

Weak defense
Helicobacter pylori
Stress, drugs, smoking 9

Gastro duodenal mucosal integrity is determined by protective
(“defensive”) and Damaging ( “ aggressive”) factors


Mucus Smoking

Blood flow Bile acid

Growth factor NSAIDs

Cell renewal PGs Hypoxia

Pathophysiology cont…

• Gastric and duodenal ulcers usually cannot be differentiated based

on history alone, although some findings may be suggestive.

• Epigastric pain is the most common symptom of both gastric and

duodenal ulcers.

• It is characterized by a gnawing or burning sensation and occurs

after meals—classically, shortly after meals with gastric ulcer and 2-

3 hours afterward with duodenal ulcer. 11

Pathophysiology cont…

• Under normal conditions, a physiologic balance exists between

gastric acid secretion and gastroduodenal mucosal defense.

• Mucosal injury and, thus, peptic ulcer occur when the balance

between the aggressive factors and the defensive mechanisms is

disrupted. 12

Pathophysiology cont…

• Aggressive factors, such as nonsteroidal anti-inflammatory drugs

(NSAIDs), H pylori infection, alcohol, bile salts, acid and pepsin can

alter the mucosal defense by allowing back diffusion of hydrogen

ions and subsequent epithelial cell injury

• The defensive mechanisms include tight intercellular junctions,

mucus, mucosal blood flow, cellular restitution, and epithelial

renewal 13

Secretion of HCl by gastric parietal cell and its regulation 14

Diagnostic tests

• Barium swallow: You drink a thick white liquid (barium) that coats

your upper gastrointestinal tract and helps your doctor see your

stomach and small intestine on X-rays

• Endoscopy (EGD): A thin, lighted tube is inserted through your

mouth and into the stomach and the first part of the small intestine

• This test is used to look for ulcers, bleeding and any tissue that

looks abnormal 15

Diagnostic tests cont..

• Endoscopic biopsy: A piece of stomach tissue is removed so it can
be analyzed in a lab. 16

Classification of antiulcer drugs

1. Reduction of gastric acid secretion

(a) H2 antihistamines: Cimetidine, Ranitidine,Famotidine, Roxatidine

(b) Proton pump inhibitors: Omeprazole, Lansoprazole, Pantoprazole,


(c) Anticholinergics: Pirenzepine, Propantheline,Oxyphenonium

(d) Prostaglandin analogue: Misoprostol 17

Antiulcer drugs cont…

2. Neutralization of gastric acid (Antacids)

(a) Systemic: Sodium bicarbonate, Sodium citrate

(b) Nonsystemic: Magnesium hydroxide, Magnesim trisilicate,

Aluminium hydroxide gel, Magaldrate, Calcium carbonate 18

Antiulcer drugs cont…

3. Ulcer protectives: Sucralfate, Colloidal bismuth subcitrate (CBS)

4. Anti-H. pylori drugs: Amoxicillin, Clarithromycin,Metronidazole,

Tinidazole, Tetracycline 19


• Peptic Ulcer(PU) is an ulcer of the GIT at an area exposed to the

acid pepsin mixture (APM),i.e.the mucosa of the GIT

• The pathophysiological structure shows aggressors like increased

acid and pepsin, an impaired defence system of the mucosa.

• Acute ulcers and erosions present clinically with gastrointestinal

bleeding or perforation 20

Thank You