Peptic Ulcer Disease

Chronic ulcers that occur in any portion of the
GIT exposed to the aggressive
action of acidic peptic juices

Defect in the mucosa that penetrates into the submucosa or deeper

98% are in the first part of the duodenum D1
or in the stomach (antrum)

DU: GU ratio is 4:1

Most often solitary, may be multiple

Duodenal ulcers are more frequent with

chronic renal failure

chronic
obstructive pulmonary disease

hyperparathyroidism
(Ca stimulates gastrin
production & acid secretion)

alcoholic cirrhosis

Epidemiology

M>F (M:F ratio in DU is
3:1 & in GU is 1.5-2:1)

all races, with little differences

usually adult

Genetics: Blood group
O and personality

Pathogenesis:

Imbalance between the mucosal defenses
and the damaging forces ----> Mucosal
exposure to gastric acid and pepsin

Key factors of peptic ulcers

NSAID use (2nd most common)

Others:

H. pylori infection, the most important

presents in 70-90%
of DU & 70% of GU

Suppression of mucosal prostaglandin
synthesis by blocking the cyclooxygenase pathway (which
helps the gastric
mucosa to stay intact and protects it from the acidic
environment by having
enough blood supply and secreting bicarbonate) & ↑ HC

alcohol,

Cushing's syndrome

Smoking,

Zollinger–Ellison

psychological stress

NSAIDS can lead to ;

Acute erosive gastritis

Acute gastric ulcer

Peptic ulceration