Peptic Ulcer

Definition of Peptic Ulcer: Peptic ulcers are chronic, most often solitary lesion occuring in any part of the GIT exposed to the aggressive action of acid peptic juices.

Or

It is a chronic ulcerative lesion of the GIT at sites exposed to aggressive action of acid peptic juices.

Peptic ulcer

Types of Peptic Ulcer:

• Duodenal Ulcer
• Gastric Ulcer

Sites of ulcer in GI tract:

1. Commonest site:First part of the duodenum on the anterior wall(about 70%)
2. Within the antral part of stomach towards the lesser curvatures close to the junction of acid secreting and non-acid secreting part.(About 28%)
3. Lower end of the esophagus (Barrett's esophagus,a site of columnar metaplasia)
4. Stomach ulcer,within the margins of a gastrojejunostomy.
5. In the duodenum,stomach or jejunum of patients with Zollinger Ellison Syndrome:Non -B cell of pancrease producing gastrin.This gastrin causes hyper secretion of gastric acid.This tumor may found in any part of GIT.
6. Mickle's diverticulum that contains ectopic gastric mucosa.

Risk factors/Causes of peptic ulcer:

Imbalance between gastric mucosal barrier (defense mechanism) and acid pepsin mixture(damaging forces):

1. Hyper acidity
2. Mucosal barrier defect(in gastric ulcer)
3. Predisposing condition:-

          a)Genetic influence(duodenal ulcer)

• Family
• 'O' negative blood group.

          b)Environmental
     4.H.pylori infection (Chronic gastritis)-About 85-100% of patients with duodenal ulcer & 65% with gastric ulcer.

Treatment of peptic ulcer:

A.Relieve pain by raising gastric pH(alkalization)

• Neutralization of gastric acid by antacids.
• Inhibition of gastric secretion by-H2 blocker,Anticholinergic drugs,PGE2
• Surgical removal -Gastrectomy

B.To prevent complication
C.To promote healing

• Bed rest & sedation-Diazepam]
• Use of ulcer healer drugs-sucralfate

D.To prevent recurrence-

• Regular diet
• Avoid ulcerogenic drugs-Aspirin,Steroids
• Avoid smoking,alcohol,tea,coffee.