Pathophysiology of
Peptic Ulcer
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Contents
• Peptic ulcer
• Pathophysiology of peptic ulcer
• Symptoms of peptic ulcer
• Anti-ulcer drugs
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Objectives
At the end of this lecture, student will be able to
• Explain the pathophysiology of peptic ulcer
• Describe the symptoms
• Classify Antiulcer drug
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Peptic ulcer
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Introduction
• 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
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Introduction cont…
• It causes inflammatory injuries in either the gastric or duodenal
mucosa, with extension beyond the submucosa into the muscularis
mucosa
• 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
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Sign & Symptoms
• Dyspepsia (Indigestion)
• Abdominal pain
• Heart burn
• Bloating (swollen state)
• Nausea
• Anorexia
• Weight loss
• Melena (Black vomit)
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Pathophysiology of PUD
Normal
Increased Attack
Hyperacidity
Weak defense
Helicobacter pylori
Stress, drugs, smoking
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Gastro duodenal mucosal integrity is determined by protective
(“defensive”) and Damaging ( “ aggressive”) factors
HCO3 H+
Mucus Smoking
Pepsin
Blood flow Bile acid
Ethanol
Growth factor NSAIDs
Ischemia
H.Pylori
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.
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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.
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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
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Secretion of HCl by gastric parietal cell and its regulation
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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
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Diagnostic tests cont..
• Endoscopic biopsy: A piece of stomach tissue is removed so it can
be analyzed in a lab.
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Classification of antiulcer drugs
1. Reduction of gastric acid secretion
(a) H2 antihistamines: Cimetidine, Ranitidine,Famotidine, Roxatidine
(b) Proton pump inhibitors: Omeprazole, Lansoprazole, Pantoprazole,
Rabeprazole,Esomeprazole
(c) Anticholinergics: Pirenzepine, Propantheline,Oxyphenonium
(d) Prostaglandin analogue: Misoprostol
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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
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Antiulcer drugs cont…
3. Ulcer protectives: Sucralfate, Colloidal bismuth subcitrate (CBS)
4. Anti-H. pylori drugs: Amoxicillin, Clarithromycin,Metronidazole,
Tinidazole, Tetracycline
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Summary
• 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
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Thank You
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