Peptic ulcer

Peptic ulcer is usually a non-malignant ulcer of the stomach (called gastric ulcer) or duodenum (called duodenal ulcer). About 4 % of gastric ulcers are caused by malignant tumour, which is why ulcers of stomach are controlled. Duodenal ulcers are non-malignant. By far most instances are now known to be due to Helicobacter pylori, a spiral-shaped bacterium that lives in the acid environment of the stomach. These ulcers can also be caused or worsened by drugs such as Aspirin and other NSAIDs.

Pathophysiology

Classical causes of ulcers (tobacco smoking, blood groups, spices and a large array of strange things) are of relatively minor importance in the development of peptic ulcers.

Related Topics:
Tobacco smoking - Blood group - Spice

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A major causative factor (90% of gastric and 75% of duodenal ulcers) is chronic inflammation due to Helicobacter pylori, a spirochaete that inhabits the antral mucosa and increases gastrin production. Gastrin, in turn, stimulates the production of gastric acid by parietal cells.

Related Topics:
Inflammation - Helicobacter pylori - Spirochaete - Gastrin - Gastric acid

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Another major cause is the use of NSAIDs (see above). The gastric mucosa protects itself from gastric acid with a layer of prostaglandins. NSAIDs block the function of cyclooxygenase 1 (cox-1), which is essential for the production of these prostaglandins. Newer NSAIDs (celecoxib, rofecoxib) only inhibit cox-2, which is less essential in the gastric mucosa, and roughly halve the risk of NSAID-related gastric ulceration.

Related Topics:
NSAID - Gastric acid - Prostaglandin - Cyclooxygenase - Celecoxib - Rofecoxib

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Glucocorticoids lead to atrophy of all epithelial tissues. Their role in ulcerogenesis is relatively small.

Related Topics:
Glucocorticoid - Epithelial

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Stress in the psychological sense has not been proven to influence the development of peptic ulcers. Burns and head trauma, however, can lead to "stress ulcers", and it is reported in many patients who are on mechanical ventilation.

Related Topics:
Burns - Head trauma - Mechanical ventilation

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Smoking leads to atherosclerosis and vascular spasms, causing vascular insufficiency and promoting the development of ulcers through ischemia.

Related Topics:
Smoking - Atherosclerosis - Ischemia

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A family history is often present in duodenal ulcers, especially when blood group O is also present. Inheritance appears to be unimportant in gastric ulcers.

Related Topics:
Family history - Blood group

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Macroscopically: Gastric ulcer is most often localized on the lesser curvature of the stomach. It is a round to oval parietal defect ("hole"), 2 to 4 cm diameter, with a smooth base and perpendicular borders. These borders are not elevated or irreguliar as in gastric cancer - ulcerative form. Surrounding mucosa may present radial folds, as a consequence of the parietal scarring.

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Microscopically: Gastric peptic ulcer is a mucosal defect which penetrates the muscularis mucosae and muscularis propria, produced by acid-pepsin aggression. Ulcer margins are perpendicular and present chronic gastritis. During the active phase, the base of the ulcer shows 4 zones: inflammatory exudate, fibrinoid necrosis, granulation tissue and fibrous tissue. The fibrous base of the ulcer may contain vessels with thickened wall or with thrombosis. 1

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