Definition: Peptic ulcer disease is an excavation (hollowed-out area) that forms in the mucosal wall of the stomach. Erosion of a circumscribed area of mucous membrane is the cause. Predisposing Factors Precipitating Factors ? Age (40-60) > Malignant tumors ? Gender > Gastric Hyperacidity ? Lifestyle (Alcohol ingestion) > Stress ? Familial tendency > Irritating Foods PS:::::::: please edit the factors!!!! Helicobacter Pylori causes: -H. pylori evades attack by the host immune system and causes chronic, indolent inflammation by several mechanisms.
-H. pylori can damage the mucosal defense system by reducing the thickness of the mucus gel layer, diminishing mucosal blood flow, and interacting with the gastric epithelium throughout all stages of the infection. -H. pylori infection can also increase gastric acid secretion; by producing various antigens, virulence factors, and soluble mediators, -H. pylori induces inflammation, which increases parietal-cell mass and, therefore, the capacity to secrete acid.
-The H. pylori cytotoxin-associated geneCagA also has an important role: it interferes with gastric epithelial cell-signaling pathways, thereby regulating cellular responses and possibly contributing to apical junction barrier disruption, interleukin-8 secretion and phenotypic changes to gastric epithelial cells. Use of NSAID’s result to: -The injurious gastrointestinal effects of NSAIDs are largely caused by the inhibition of COX1 and its role in normal mucosal defense mechanisms – the inhibition of thromboxane A2, which compromises platelet function and results in gastrointestinal bleeding. ———————– Damage to mucosa with alcohol abuse, smoking, use of aspirin & NSAID’s.
Acid & pepsinogen release with chronic vagal response to increased stress Damaged mucosal barrier Infection with Helicobacter Pylori Imbalance of aggressive & defensive factor Low function of mucosal cells; low quality of mucous; less of tight junction between cells Erosive gastritis: inflammation >> decreased acid and intrinsic factor Infection gives increased gastrin & decreased somatostatin production A damage mucosa could not secrete enough mucus to act as a barrier against gastric acid. Severe ulcerations: Signs and symptoms: Epigastric pain Hematemesis Dyspepsia pyrosis Mucosal ulcerations, possible bleeding and scarring.