Pathophysiology of Peptic ulcer

A peptic ulcer, also.known. as a gastric or duodenal ulcer characterized by damage of mucosal lining of the stomach, first part of the small intestine (duodenum). Peptic ulcers occurs as a imbalance between the protective mechanisms maintaining the gastric mucosa and the aggressive factors that can causing damage upon the gastric mucosa.

Epidemiology of Peptic Ulcer

Peptic ulcers may manifest in various regions across the globe, with the occurrence. and distribution of this condition exhibiting variability. In India, peptic ulcer disease.is more common, with distinct patterns observed in its prevalence.

Peptic ulcer rates vary by geography. Japan, Korea, and Southeast Asia have greater rates of peptic ulcers. However, healthcare and risk factors have reduced incidence.in these regions. Developing countries with poor socioeconomic status and limited healthcare have the highest prevalence rates.

Peptic ulcers exhibit a notably elevated prevalence within the geographical confines of India, thereby exerting a substantial impact upon a considerable cohort of individuals spanning the nation. The prevalence rates exhibit variability across diverse geographical regions and populations within the Indian context. Peptic ulcer disease incidence varies across India's various regions.

Helicobacter.pylori Infection

Major risk factor.for peptic ulcers is Helicobacter pylori infection. This infection.is spread by widespread lack of cleanliness and poor hygiene. In India, the cases of H. pylori infections is very high. Studies.have shown that there are.considerable regional variations.in the frequency of H. pylori infection in India, with rates.ranging from 30 to 80 percent.

Socioeconomic Factors

Socioeconomic factors affect peptic ulcer disease distribution. Peptic ulcers are more frequent in low-income backgrounds, overcrowded, and without health coverage groups. These variables may increase H. pylori infection and delay peptic ulcer diagnosis and treatment.

Lifestyle and Dietary Factors

Lifestyle and nutrition can spread peptic ulcers. Peptic ulcers have been associated to spicy food, alcohol, smoking, and stress. These risk factors may alter depending on the demographic and cultural practises. In India, lifestyle factors influence the prevalence of peptic ulcers.

Causes of Peptic Ulcer

The following.are the basic causes of peptic ulcers:

Helicobacter pylori (H-pylori) Infection

The gastric and duodenal.mucosa is prone to Helicobacter pylori infection. It is the most important factor for gastric ulceration. The susceptibility of the stomach and duodenum to acid increased. H. Pylori breaks the gastric mucosa. Helicobacter pylori responsible for 80% of duodenal.ulcers and 70% of stomach ulcers.

Non-steroidal Anti-inflammatory Drugs (NSAIDs)

Aspirin, ibuprofen, and.naproxen can cause peptic ulcers. These drugs inhibits prostaglandin production. Prostaglandins boost stomach mucosa protection. Chronic use of NSAID's may more likely to develop peptic ulcers.

Excessive Stomach Acid Production:

Some infections and health conditions can cause excess stomach acid production.

Lifestyle Factors

Examples of these factors include smoking, drinking large amounts of alcohol, and experiencing high levels of psychological stress.

Genetic Factors

Gastric ulcers can sometimes caused by a person's genes.

Other Factors

Peptic ulcers also produced by a various other factors, but these are less common. Crohn's disease, some types of cancer, burns, radiations and stress-related mucosal injury are the other causes of gastric ulcers.

Signs and Symptoms Peptic Ulcer

Abdominal pain
Indigestion
Dyspepsia
Feelings of fullness
Bloating
Discomfort in the upper abdomen.
Heartburn
Acid reflux
Nausea and vomiting
Loss of appetite
Weight loss
Dark or bloody stools
Fatigue
Iron deficiency anemia
Weakness
Pale skin

Clinical Manifestation of Peptic Ulcer

The clinical manifestation of a peptic ulcer can vary depending on various factors, such as the ulcer's specific location and size, the existence of any associated complications, and individual variations. The subsequent paragraphs outline the customary clinical manifestations associated with peptic ulcers.

Abdominal Pain

Peptic ulcers commonly produce gastric discomfort. The sensation experienced in the upper abdomen is commonly described as dull, burning, or .gnawing. The intensity and frequency of pain can exhibit variability. Typically, this phenomenon manifests either in the absence.of food consumption or a few hours subsequent to a meal.

Indigestion

Peptic ulcers.cause dyspepsia, or indigestion, especially after a heavy dinner with spicy or fatty meals.

Heartburn

Heartburn is a common sign of peptic ulcers. Heartburn often happens after eating or at night.

Vomiting

Nausea and vomiting.are common symptoms of peptic ulcers.

Anorexia and Weight Loss

Loss of appetite and unintended weight loss are complications of peptic ulcer disease. The pain and discomfort that occurs after eating might be the cause of the symptoms.

Gastrointestinal Bleeding

A peptic ulcer has the potential to cause bleeding, which may manifest as either overt bleeding or occult bleeding (not visibly apparent). Overt bleeding has the potential to result in the manifestation of dark, tarry stools, commonly referred to as melena, or stools that display an intense red coloration due to the presence of fresh blood, known as hematochezia. Manifestations of occult bleeding may include symptoms such as iron deficiency anaemia, fatigue, weakness, and a pale skin.

Complications

Untreated or severe peptic ulcers can induce gastric outlet obstruction, which prevents food from entering the small intestine. Chronic vomiting, bloating, and.weight loss may result. A stomach.or duodenal ulcers can cause significant abdominal discomfort and require immediate medical care.

Pathogenesis of Peptic Ulcer

Peptic ulcers develop when aggressive factors damage the stomach or duodenal lining and protective systems maintain the mucosal barrier.

Complex molecular mechanisms and interactions cause peptic ulcers. Major molecular mechanisms in peptic ulcer include:

Helicobacter pylori Infection

H. pylori produces.urease enzyme, cytotoxins, and.flagella, which help it colonise in the stomach membrane.
This bacteria cause’s inflammation, therefore immune cells to move in, inflammatory mediators are liberated, and immune signaling pathways to be activated.
H. pylori damage the tight junctions of epithelial cells and invade into the stomach wall.
H. pylori causes the release of reactive oxygen species (ROS), which damage the stomach lining by oxidative stress.

Acid and Pepsin Secretion

Histamine H2, gastrin, and cholinergic receptors activate stomach parietal cells to secrete more acid.
An excessive secretion of acid cause gastric mucosal damage.

Impaired Mucus and.Bicarbonate Secretion

Mucus protects.the gastrointestinal mucosa from acid and other irritants.
Helicobacter pylori can damage the mucosal layer.
Prostaglandins affect mucus and bicarbonate formation, and NSAIDs can impair mucosal defences.

Inflammatory Response

Inflammatory cells such neutrophils, monocytes, and.lymphocytes are recruited during H. pylori infections.
Cytokines including.IL-1, TNF-α, and IL-8 cause tissue damage and ulcers.
Inflammation interferes with stomach mucosa repair and regeneration, slowing ulcer healing.

Angiogenesis and Blood Flow

Angiogenesis is the process.through which new blood vessels are formed. These new blood.vessels supply oxygen and nutrients to wounded tissue, which is essential to ulcer healing.
Inflammation and infection disrupt blood vessel creation, resulting in reduced blood flow and a longer healing time.

Cell Signaling and Growth Factors

EGFR, MAPK, and NF-B pathways regulate gastric mucosa cell proliferation, survival, and inflammatory responses.
Disrupting these complicated signalling pathways might affect the balance between cell proliferation and cell death, hindering stomach mucosa repair and regeneration.

Management of peptic ulcer

The aim of peptic ulcer.therapy is to mitigate symptoms, improve the healing process of ulcers. Several preferred approaches to treat peptic ulcers are outlined below.

Medications

Proton Pump Inhibitors (PPIs)

PPIs are an essential component of peptic ulcer therapy. They reduce the formation of stomach acid and promote in ulcer repair. Omeprazole, esomeprazole, lansoprazole, and.pantoprazole are PPIs that are frequently administered.

Antibiotics

Peptic ulcers caused by H. pylori.infection are treated with a combination of antibiotics. Amoxicillin, clarithromycin, metronidazole, and.tetracycline are some of the most commonly prescribed antibiotics for treating H. pylori. Antibiotic selection is also influenced by patient specific factors and develops of antibiotic resistance.

H2 Blockers

H2 blockers, like ranitidine and famotidine, inhibit the production of acid in the stomach, but these are not as efficient as PPIs. They can be used when PPIs aren't an appropriate choice or as an extra treatment.

Cytoprotective Agents

Sucralfate and misoprostol may be administered to support the protective mucus layer and facilitate healing.

Antacids: By neutralising stomach acid, antacids can give symptomatic relief. They are frequently used as a supplement to therapy for short-term symptom mitigation.

Lifestyle and Dietary Modifications

Avoiding Triggers

Patients are recommended to avoid substances like coffee, alcohol, spicy meals, acidic foods, and smoking that might make their symptoms worse.

Healthy Eating

It is advised to follow a balanced diet and eat smaller, more frequent meals. Lean proteins, fruits, vegetables, and fiber-rich diets can all help to improve digestive health overall.

Stress Management

Exercise, relaxation methods, and counselling are all effective stress-reduction strategies that can help you manage the symptoms of stress.

Discontinuation or Modification of NSAID Use

If the peptic ulcer is caused by NSAID usage, the healthcare professional may advise stopping or adjusting NSAID use. Alternative pain treatment measures or the use of less ulcerogenic NSAIDs may be investigated.

Follow-up and Monitoring

To monitor the ulcer's healing progress, evaluate symptom management, and make any needed alterations to the treatment plan, regular follow-up visits with the healthcare professional are essential.