A peptic ulcer is defined as disruption of the mucosal integrity of the stomach and/or duodenum leading to a local defect or excavation due to active inflammation.
Peptic ulcers include:
1.Gastric ulcers that occur on the inside of the stomach
2.Duodenal ulcers that occur on the inside of the upper portion of your small intestine (duodenum)
Normal Gastroduodenal Mucosal Defense mechanism
The gastric epithelium is under constant assault by a series of endogenous noxious factors, including hydrochloric acid (HCl), pepsinogen/pepsin, and bile salts. In addition, a steady flow of exogenous substances such as medications, alcohol, and bacteria encounter the gastric mucosa.
The first line of defense is a MUCUS-BICARBONATE- PHOSPHOLIPID LAYER, which serves as a physicochemical barrier to multiple molecules, including hydrogen ions.
- The mucous gel functions as a nonstirred water layer impeding diffusion of ions and molecules such as pepsin.
- Bicarbonate forms a pH gradient ranging from 1 to 2 at the gastric luminal surface and reaching 6–7 along the epithelial cell surface.
The Second line of defense is SURFACE EPITHELIAL CELLS it produce mucus production, epithelial cell ionic transporters that maintain intracellular pH and bicarbonate production, and intracellular tight junctions. . Surface epithelial cells generate heat shock proteins that prevent protein denaturation and protect cells from certain factors such as increased temperature, cytotoxic agents, or oxidative stress.
The third line of defense
- If the preepithelial barrier were breached, gastric epithelial cells bordering a site of injury can migrate to restore a damaged region (restitution).
- Prostaglandins play a central role in gastric epithelial defense/ repair
- Nitric oxide is important in the maintenance of gastric mucosal integrity
Physiology of Gastric Secretion
- HCl and pepsinogen are the two principal gastric secretory products capable of inducing mucosal injury. Gastric acid and pepsinogen play a physiologic role in protein digestion; absorption of iron, calcium, magnesium, and vitamin B12; and killing ingested bacteria.
- Stimulated gastric acid secretion occurs primarily in three phases based on the site where the signal originates (cephalic, gastric, and intestinal).
- Sight, smell, and taste of food are the components of the cephalic phase, which stimulates gastric secretion via the vagus nerve.
- The gastric phase is activated once food enters the stomach. This component of secretion is driven by nutrients.
- The intestinal phase initiated as food enters the intestine and is mediated by luminal distention and nutrient assimilation.
Peptic ulcer Causes
- Helicobacter pylori bacteria commonly live in the mucous layer that covers and protects tissues that line the stomach and small intestine. Often, the H. pylori bacterium causes no problems, but it can cause inflammation of the stomach’s inner layer, producing an ulcer.
- Use of certain pain killer- Ibuprofen, diclofenac
- Nonsteroidal anti-inflammatory drugs (NSAIDs)- Paracetamol
- Eating spicy food
- Skipping of food
- Chemical farming -Insecticide,Pesticide,Rodenticide,Weedicide
Peptic ulcer Symptoms
- Burning stomach pain
- Feeling of fullness, bloating or belching
- Fatty food intolerance
- Vomiting or vomiting blood — which may appear red or black
- Dark blood in stools, or stools that are black or tarry
- Trouble breathing
- Feeling faint
- Nausea or vomiting
- Unexplained weight loss
- Loss of Appetite
Peptic ulcer Complications
- Internal bleeding. Bleeding can occur as slow blood loss that leads to anemia.
- Peptic ulcers can block passage of food through the digestive tract
- Avoid chemical pesticides, chemical fertilizer for farming
- Avoid herbicides
- Avoid weedicides
- Avoid rodenticide
- Eat organic fruits, vegetable
- Regular exercise
- Avoid smoking
- Eating foods high in fiber
- Drinking an adequate amount of fluids
- Avoid alcohol
- Avoid tobacco
- Avoid pain killer
- Avoid antibiotic
- Protect yourself from infections. You can take steps to protect yourself from infections, such as H. pylori, by frequently washing your hands with soap and water and by eating foods that have been cooked completely.
- Avoid stress
Tests for H. pylori- H. pylori is diagnosed by using a blood, stool or breath test. The breath test is the most accurate.