Key Causes and Symptoms of Peptic Ulcers Explained
Our body develops sores due to various reasons. When it happens in the interior lining of the stomach, small intestine, and lower esophagus, it is called a peptic ulcer. In this section, we will study how peptic ulcers form and how they can be prevented from recurring. We will also discuss the treatment plans and how one can reduce the risk of developing such ulcers in the digestive system. Let us study the pathology of peptic ulcer disease and then proceed to its symptoms and treatment.
What is Peptic Ulcer Disease?
The formation of open sores in the interior lining of the stomach, small intestine, and the lower esophagus or the food pipe is called a peptic ulcer. The inner lining of these organs breaks causing perforations. This perforation exposes the vulnerable interior tissues of the organs to the digestive enzymes. It also happens due to the infection caused by the excessive growth of Helicobacter pylori bacterium.
As per the pathology of peptic ulcer disease, it is of three types considering the location.
Gastric Ulcers
This ulcer forms in the inner lining of the stomach. The pathophysiology of gastric ulcer suggests that the inner lining of tissues that protects the organ from a highly acidic environment forms a perforation. This perforation can happen due to the H. pylori infection or for various other reasons. The breaking of this tissue exposes the internal tissues to the acidic environment causing more harm.
Esophageal Ulcers
As per the name, the ulcerative formations take place at the lower level of the food pipe. These sores open the inner lining of the food pipe increasing vulnerability to infections and the development of other grave diseases.
Duodenal Ulcers
The first portion of the small intestine that emerges from the pyloric end of the stomach is called the duodenum. The formation of perforations in this section of the small intestine is called a duodenal ulcer.
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Pathology of Peptic Ulcer Disease
The discontinuation of the gastric epithelium, the prime defensive mucosal layer that protects the inner tissues, causes perforations. These perforations also happen due to erosion of this layer from the increased population of Helicobacter pylori signifying the occurrence of an infection. The increased growth of this bacterium that generally resides inside the GI tract can cause ulcers. In fact, research suggests that the consumption of non-steroidal anti-inflammatory drugs (NSAIDs) for a prolonged period can also cause the formation of peptic ulcers.
Whenever a patient suffers from recurrent stomach pain within 15-30 minutes of consuming food, he is recommended to take an H. pylori test to check the increase in the population of this bacterium. In chronic cases, an endoscopy is done to detect the condition and location of the ulcers in the GI tract. If you follow the peptic ulcer pathophysiology flow chart below, you will understand how this disease develops.
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Symptoms of Peptic Ulcers
The common symptoms of peptic ulcers are:
Burning sensation in the stomach
Recurring pain after eating a meal
Heartburn
Intolerance to oily and fatty food
Nausea
Chest pain
Vomiting
Dark stools due to the presence of blood
A drastic change in appetite
Unexplained loss of weight
These symptoms generally indicate something wrong with the GI tract and its digestion process. The pain in a particular area can signify the presence of ulcers in those regions. The pain can range from mild to severe. It can happen mostly at night when the patient lies down. The pain can also sometimes radiate from chest to navel. Small ulcers might not show any symptoms at an early stage. The symptoms surface when these ulcers grow in size.
As per the chronic gastric ulcer histology, the ulcerative regions are filled with inflamed debris of tissues. These regions are also infiltrated by white blood cells due to the H. pylori infection and inflammation.
Treatment of Peptic Ulcer
The treatment of the ulcers in the GI tract is designed based on their chronicity and stage. If the pathology of peptic ulcer disease suggests bacterial infection then the specialist doctors will prescribe a combination of antibiotics and proton pump inhibitors (PPIs). PPIs are medicines that reduce the formation of acid in the stomach so that the erosion can be stopped and treatment can be utilized effectively.
The antibiotic will stop the growth of H. pylori and will heal the inflammation. If it has reached an advanced stage, it might need invasive procedures. Many refractory ulcers do not heal with such treatment plans. Sometimes, patients smoke and drink alcohol making the treatment ineffective.
Conclusion
Peptic ulcers either form due to the H. pylori infection or due to prolonged use of NSAIDs. The peptic ulcer pathophysiology flow chart shows how this disease develops step by step. The symptoms might vary depending on the chronicity of the disease. Study the pathophysiology of this disease to understand what it can cause and how it can be prevented.
FAQs on Peptic Ulcer: Complete Guide for Biology Students
1. What is a peptic ulcer from a biological perspective?
From a biological perspective, a peptic ulcer is an open sore or lesion that develops on the inner lining (mucosa) of the gastrointestinal tract. This occurs when the protective mucous layer is eroded, exposing the underlying tissue to the corrosive effects of gastric acid and digestive enzymes like pepsin. These ulcers are most commonly found in the stomach (gastric ulcer) or the first part of the small intestine (duodenal ulcer).
2. What are the two primary causes of peptic ulcers?
The two main causes of peptic ulcers are:
- Infection with Helicobacter pylori (H. pylori) bacteria: This bacterium lives in the mucous layer of the stomach and can cause inflammation, leading to a breakdown of the protective lining.
- Long-term use of Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Medications like ibuprofen and aspirin can interfere with the stomach's ability to protect itself from its own acid, making it more susceptible to ulcer formation.
3. How does an H. pylori infection specifically lead to the formation of a peptic ulcer?
The bacterium Helicobacter pylori causes ulcers through a multi-step process. First, it secretes an enzyme called urease, which neutralises stomach acid in its immediate vicinity, allowing it to survive. The bacterium then burrows into the protective mucus layer and attaches to the stomach lining. Its presence triggers a persistent inflammatory response and releases toxins that damage the mucosal cells. This chronic inflammation weakens the protective barrier, allowing stomach acid to seep through and create a painful ulcer.
4. What are the different types of peptic ulcers based on their location in the digestive system?
Peptic ulcers are primarily classified by their location:
- Gastric Ulcers: These occur on the inside lining of the stomach.
- Duodenal Ulcers: These form in the upper part of the small intestine, known as the duodenum.
- Esophageal Ulcers: These are less common and develop inside the lower part of the esophagus, often associated with acid reflux.
5. What is the basic pathophysiology of a peptic ulcer?
The pathophysiology of a peptic ulcer involves an imbalance between aggressive factors (which damage the mucosa) and defensive factors (which protect it). Aggressive factors include gastric acid, pepsin, and H. pylori. Defensive factors include the mucus-bicarbonate barrier, prostaglandins (which promote mucus production and blood flow), and the rapid regeneration of epithelial cells. When aggressive factors overwhelm the defensive mechanisms, the mucosal lining breaks down, resulting in an ulcer.
6. Why does long-term use of NSAIDs increase the risk of developing a stomach ulcer?
Long-term use of NSAIDs increases ulcer risk because these drugs inhibit the production of enzymes called cyclooxygenase (COX). These enzymes are necessary for producing prostaglandins, which play a critical role in protecting the stomach. Prostaglandins help maintain the mucus barrier, promote bicarbonate secretion to neutralise acid, and ensure adequate blood flow for tissue repair. By reducing prostaglandin levels, NSAIDs compromise these defences, leaving the stomach lining vulnerable to acid-induced damage.
7. What are the main biological principles behind the treatment of peptic ulcers?
The treatment for peptic ulcers focuses on two main biological principles: eradicating the cause and reducing acid damage. This is typically achieved by:
- Using antibiotics to kill the H. pylori bacteria, if present.
- Prescribing medications like Proton Pump Inhibitors (PPIs) or H2-receptor blockers to decrease the production of stomach acid.
- Using antacids to neutralise existing acid and provide immediate symptom relief.
This combined approach allows the ulcer to heal and prevents its recurrence.
8. How can a peptic ulcer be diagnosed using modern diagnostic techniques?
A peptic ulcer is typically diagnosed through a procedure called an upper endoscopy (esophagogastroduodenoscopy or EGD). During this test, a thin, flexible tube with a camera is passed down the throat to directly visualise the esophagus, stomach, and duodenum. The doctor can identify the ulcer and may take a small tissue sample (biopsy) to test for H. pylori or rule out other conditions. Non-invasive tests for H. pylori, such as a urea breath test or a stool antigen test, are also commonly used.
9. Why is lifestyle management, such as avoiding stress and smoking, often recommended alongside medical treatment for peptic ulcers?
Lifestyle management is crucial because certain factors can worsen ulcers or slow down the healing process. While stress does not directly cause ulcers, it can increase the secretion of gastric acid. Smoking impairs the stomach's natural defence mechanisms, reduces blood flow needed for healing, and increases the risk of ulcer recurrence. Similarly, excessive alcohol consumption can irritate and erode the mucosal lining. Therefore, managing these factors supports the effectiveness of medical treatment and promotes long-term digestive health.
