Peptic Ulcer Disease

I was talking to a lady yesterday, and all of a sudden, she started to groan in pains, squeezing her abdomen. She became uncomfortable all of a sudden, and even a blind person could tell that she was in pains. I was forced to ask what was wrong, and she said she felt this pain in her abdomen, and it started since she became inconsistent in her eating routine. She has been going for a long period of time without eating for a while now, and she has been feeling this pain once in a while after a long period of feeling hungry. Does prolonged periods without food tend to lead to Peptic Ulcer? What is Peptic Ulcer? In this post, I will do my best to explain what you need to know about Peptic Ulcer.

https://commons.wikimedia.org/wiki/File:Gastric_Ulcer

Peptic Ulcer Disease Epidemiology

Peptic ulcer is a global problem with a risk of development of 5% to 10%. In 2019, research showed that globally, Peptic Ulcer Disease is said to have a prevalence of 8.09 million people. Another article showed a prevalence rate of 6 to 12% in the United States. Duodenal ulcers are more common than gastric ulcers, occurring more in men than in women.

Peptic Ulcer is the open sore, lesion, or discontinuation of the lining of the stomach, and/or upper part (proximal) of the duodenum (gastrointestinal tract), or the lower part of the esophagus, as a result of acids corroding the wall of the stomach. When the ulcer is in the stomach, it is known as Gastric Ulcer, when it is in the duodenum, it is referred to as Duodenal Ulcer. The gastrointestinal tract (stomach) is made up of the Mucosa which consists of the Epithelial layer, the Lamina Propria, and the Muscularis Mucosa. The Epithelial layer of the stomach is the inner layer, the Lamina Propria is the middle layer, while the Muscularis Mucosa is the outermost layer.

The Stomach is made up of three parts, the Cardia, Fundus and pylorus (in some cases, it is regarded as four parts when the body is added.) The Fundus produces the digestive gastric juice which are Hydrochloric acids and pepsinogen, the Cardia secretes mucus (Water and glycoproteins), The pyloric antrum have G cells that secrete gastrin. The Mucous is secreted to protect the stomach from the acids being secreted to digest food. In the Duodenum, the same thing is done by the Brunner Glands which secretes mucin, which protects the duodenum from acid being secreted. Thanks to the mucus being secreted by the stomach and the duodenum which neutralizes the acid, both the stomach and the duodenum would have been digested by the acid being secreted by themselves. Gastric Ulcer is commonly located in the lesser curvature, while duodenal ulcer is located in the duodenal bulb.

Peptic Ulcer Etiology

Peptic ulcer is commonly caused by the bacteria Helicobacter pylori, and Nonsteroidal anti-inflammatory drug. Other causes in rare cases are; Cancerous and non-cancerous cells (Zollinger-Ellison syndrome), Viral infection, Stress (burns), and so on.

Helicobacter pylori are gram negative Bacillus bacteria that can live and colonize the digestive tract of humans. It is acquired in childhood and, until treated, it remains in the gastrointestinal tract. According to research titled, Role of Helicobacter pylori eradication in aspirin or non-steroidal anti-inflammatory drug users, about half of the world population have H. pylori in their tract, and not all of them have ulcer. H.pylori is responsible for about 70% - 90% of all duodenal and gastric ulcers. This bacterium is common in countries with low income and low socioeconomic status. They poccess a wide spectrum of virulence factors that allows them to adhere to the faveolar cells and inflame the gastric mucosa (like protease which damage the mucosa cells). It could begin in the Pylori and then extend to the duodenum and other parts of the stomach. H.pylori secretes urease which breaks down urea into ammonia, thereby neutralizing the acidic gastric environment, and so doing, protecting them from the acidic environment. H.pylori secretes toxins (CagA/VagA) which causes stomach mucosal inflammation and damage, and also flagella to move around the gastric epithelium in the gastrointestinal tract.

NonSteroidal Anti-Inflammatory Drugs are another cause of Peptic ulcer. Drugs such as Ibuprofen inhibits cyclooxygenase enzyme (COX-1 enzyme) which blocks prostaglandin secretion which protects the gastric mucosa. This causes the gastric mucus, and bicarbonate production to decrease. Research titled Risk of upper and lower gastrointestinal bleeding in patients taking nonsteroidal anti-inflammatory drugs, antiplatelet agents, or anticoagulants showed that nonsteroidal anti-inflammatory drugs (NSAIDs), and low-dose aspirin treatments were associated with upper and lower gastrointestinal bleeding which could cause mucosal injury and peptic ulcer.

Zollinger-Ellison Syndrome is also another cause of Peptic ulcer. It is caused by a neuroendocrine tumor known as Gastrinoma, which is located in the pancreas and the Duodenal wall. These cases the abnormal secretion of gastrin, which causes the parietal cells to produce excess Hydrochloric acid beyond what the normal defense mechanism of the duodenum or jejunum.

Signs, Symptoms, and Diagnosis of Peptic Ulcer Disease

Common physical signs includes; Epigastric abdominal pain, Nausea and vomiting, Hematemesis (vomiting blood), Melena (black stools), and bloating. The signs and symptoms of peptic ulcer vary depending on the location of the ulcer.
Certain diseases could possess similar symptoms to Peptic Ulcer Disease, they are Gastritis, Gastroesophageal reflux disease (GERD), Gastric Cancer, Pancreatitis, Biliary colic, and Cholecystitis.

Peptic Ulcer Disease Treatment

Treatment for Peptic ulcer Disease includes antisecretory drugs such as H2-receptor antagonists, Proton Pump inhibitors, which blocks acid production in the stomach, promotes healing and provide relief from the pain. Stopping the use of Nonsteroidal Anti-Inflammatory Drugs (NSAIDs). Drugs like Misoprostol (prostaglandin analogs) can be used as prophylaxis in cases of NSAIDs induced peptic Ulcer. In cases where the patient isn't responding to drugs, surgical sessions might be required.

Reference

https://www.ncbi.nlm.nih.gov/books/NBK534792/

https://www.sciencedirect.com/topics/nursing-and-health-professions/peptic-ulcer

https://www.healthdirect.gov.au/duodenal-ulcer

https://training.seer.cancer.gov/anatomy/digestive/structure.html

https://www.kenhub.com/en/library/anatomy/stomach-histology

https://pubmed.ncbi.nlm.nih.gov/25460554/

https://www.webmd.com/digestive-disorders/h-pylori-helicobacter-pylori

https://www.hopkinsmedicine.org/health/conditions-and-diseases/helicobacter-pylori

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4504877/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6140150/

https://www.healthline.com/health/gastrinoma