Peptic Ulcer Disease and Achlorhydria

Peptic Ulcer Disease

• Condition characterized by Erosion of GI mucosa resulting from digestive action of excessive HCl and pepsin

Location of ulcer

– Duodenum (duodenal ulcer)….most common

– Stomach(gastric ulcer)– Lower

esophagus(esophageal ulcer)

TYPES

• Acute – Superficial erosion– Minimal erosion

• Chronic– Muscular wall erosion with formation of fibrous

tissue – Present continuously for many months or

intermittently

Causes of peptic ulcer

• Peptic ulcers are the end result of an imbalance between digestive fluids in the stomach and duodenum.

• Ulcers can be caused by:– Infection with a type of bacteria called Helicobacter pylori

(H. pylori)– Use of painkillers called nonsteroidal anti-inflammatory

drugs (NSAIDs), such as aspirin, ibuprofen– Excess acid production from gastrinomas, tumors producing

gastrin which act on the acid producing cells of the stomach that increases acid output (Zollinger-Ellison syndrome).

• (Zollinger-Ellison syndrome) is caused by a gastrin-secreting tumor of the pancreas that stimulates the acid-secreting cells of the stomach to maximal

activity, with consequent gastrointestinal mucosal ulceration

People at risk of developing ulcers

• Those who are infected with the H. pylori bacterium

• Take NSAIDs such as aspirin, ibuprofen

• Have a family history of ulcers

• Drink alcohol regularly

• Are 50 years old or older

• Stress/anxiety

Protection of gastric mucosa

• Two mechanisms– Mucus forms a layer that entraps or slows

diffusion of hydrogen ions(HCl) across mucosal barrier

– Bicarbonate is secreted• Neutralizes HCl acid in lumen of GI tract

SIGN AND SYMPTOMS• An ulcer may or may not have symptoms. When symptoms occur, they

may include:• A burning pain in the middle or upper stomach between meals or at

night• Heartburn• Nausea or vomiting• Bloating

• In severe cases, symptoms can include:• Dark or black stool (due to bleeding)• Vomiting blood (that can look like "coffee-grounds")• Weight loss• Severe pain in the mid to upper abdomen

COMPLICATIONS

• 3 major complications– Hemorrhage– Perforation– Gastric outlet obstruction

DIAGNOSIS

• Medical History • Laboratory analysis– CBC (complete blood count)– Liver enzyme studies– Stool examination

• Barium contrast studies

• Tests for H. pylori– Noninvasive tests• Serum or whole blood antibody tests

– Immunoglobin G (IgG)• Urea breath test

– Invasive tests• Biopsy of stomach

Endoscopy procedure most often used

– Determines degree of ulcer healing after treatment– Tissue specimens can be obtained to identify H. pylori and to rule out gastric cancer

How Are Ulcers Treated?

• Lifestyle Changes to Treat an UlcerTo treat an ulcer, first eliminate substances that

can be causing the ulcers. If you smoke or drink alcohol, stop. If the ulcer is believed to be caused by the use of NSAIDs, they need to be stopped.

• Ulcer Medications

Proton pump inhibitors (PPI). Proton pump medications reduce acid levels and allow the ulcer to heal

Antibiotics. If you have H. pylori infection, then antibiotics are used.

• Upper Endoscopy: Some bleeding ulcers can be treated through an endoscope.

• Surgery. Sometimes an operation is needed if the ulcer has created a hole in the wall of the stomach or if there is serious bleeding that can't be controlled with an endoscope

Will Drinking Milk Help Cure an Ulcer?

• No. In fact, milk can make an ulcer worse. Milk provides brief relief of ulcer pain because it coats the stomach lining. But milk can also stimulate the stomach to produce more acid and digestive juices, which can aggravate ulcers.

ACHLORHYDRIA

• Achlorhydria or hypochlorhydria refers to states where the production of gastric acid in the stomach is absent or low, respectively.

• Because of low or absent HCl, protein digestion is impaired because HCl is required for the activation of pepsinogen into pepsin.

• Bacterial growth in stomach(HCl have antiseptic effect)

CAUSES

• Autoimmune disorders where there is antibody production against parietal cells which normally produce gastric acid.

• The use of antacids or drugs that decrease gastric acid production (such as H2-receptor antagonists) or transport (such as proton pump inhibitors)

• atrophic gastritis • tomach cancer. • Radiation therapy involving the stomach. • GASTRECTOMY

THE END