Peptic ulcers are painful sores in the stomach or small intestine. They're caused by too much stomach acid, H. pylori bacteria, or NSAIDs . Left untreated, they can lead to serious complications like bleeding or perforation .
Treatment involves medications to reduce acid and kill bacteria. Diet changes help too. Avoiding irritants like spicy foods and eating smaller meals can soothe symptoms. Probiotics and nutrients like zinc may speed up healing.
Peptic Ulcer Pathophysiology
Causes and Mechanisms of Peptic Ulcers
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Peptic ulcers form when stomach acid erodes the lining of the digestive tract, creating open sores in the stomach or duodenum
Helicobacter pylori bacteria infect the stomach lining, weakening its protective mucus layer and increasing acid production
Gastric acid overproduction overwhelms the stomach's natural defenses, leading to tissue damage and ulcer formation
NSAIDs (Aspirin, Ibuprofen) reduce protective prostaglandins in the stomach, making the lining more susceptible to acid damage
Gastritis involves inflammation of the stomach lining, increasing vulnerability to ulcer development
Acute gastritis occurs suddenly and can be caused by alcohol, stress, or certain medications
Chronic gastritis develops over time and is often associated with H. pylori infection
Risk Factors and Complications
Smoking increases stomach acid production and impairs healing of the stomach lining
Excessive alcohol consumption irritates and erodes the mucous lining of the stomach
Stress can increase stomach acid production and decrease blood flow to the stomach
Complications of untreated peptic ulcers include:
Internal bleeding
Perforation of the stomach or small intestine
Gastric outlet obstruction
Types of Peptic Ulcers
Duodenal Ulcers
Occur in the first part of the small intestine (duodenum)
More common than gastric ulcers, accounting for about 80% of peptic ulcers
Often associated with increased acid production
Symptoms typically worsen when the stomach is empty and improve after eating
Pain is often described as burning or gnawing, located in the upper middle part of the abdomen
Gastric Ulcers
Develop in the lining of the stomach
Less common than duodenal ulcers but potentially more serious
Often associated with reduced protective factors in the stomach lining
Symptoms may worsen shortly after eating
Can be associated with gastric cancer in some cases, requiring careful monitoring and follow-up
Pain is typically located in the upper left part of the abdomen
Pharmacological Treatments
Acid-Reducing Medications
Antacids neutralize existing stomach acid to provide quick relief from symptoms
Work by increasing the pH of the stomach contents (Calcium carbonate, Magnesium hydroxide)
Provide temporary relief but do not address the underlying cause of ulcers
Proton pump inhibitors (PPIs) block acid production by inhibiting the proton pump in gastric parietal cells
Highly effective in reducing acid secretion (Omeprazole , Esomeprazole )
Used for both treatment and prevention of peptic ulcers
Can lead to long-term side effects if used extensively (nutrient malabsorption , increased risk of infections)
H2 receptor antagonists block histamine receptors in the stomach, reducing acid production
Less potent than PPIs but still effective for many patients (Ranitidine , Famotidine )
Fewer side effects compared to PPIs, making them suitable for long-term use in some cases
Antibiotics and Cytoprotective Agents
Triple therapy combines two antibiotics with a PPI to eradicate H. pylori infection
Typically includes clarithromycin , amoxicillin , and a PPI (Omeprazole)
Treatment duration usually lasts 7-14 days
Bismuth subsalicylate acts as a protective coating for the ulcer and has antimicrobial properties
Often used in quadruple therapy for H. pylori eradication
Can cause temporary darkening of the tongue and stool
Nutritional Therapy
Dietary Modifications and Restrictions
Dietary modifications aim to reduce irritation and promote healing of the ulcerated area
Avoid foods that increase stomach acid production (Caffeine, alcohol, spicy foods)
Consume smaller, more frequent meals to prevent excessive acid accumulation
Incorporate foods rich in flavonoids (Berries, apples, legumes) to support stomach lining health
Probiotics introduce beneficial bacteria to the digestive system
Help restore balance to the gut microbiome, potentially inhibiting H. pylori growth
Can be consumed through fermented foods (Yogurt, kefir, sauerkraut) or supplements
May enhance the effectiveness of antibiotic treatment for H. pylori
Micronutrient Support for Healing
Zinc plays a crucial role in wound healing and maintaining the integrity of the gastrointestinal lining
Supports the production of stomach acid and enzymes necessary for proper digestion
Found in high concentrations in oysters, beef, and pumpkin seeds
Supplementation may accelerate ulcer healing, especially in zinc-deficient individuals
Vitamin A contributes to the maintenance and repair of epithelial tissues, including the stomach lining
Supports the production of mucus, which protects the stomach from acid damage
Found in both animal sources (Liver, eggs) and plant sources (Sweet potatoes, carrots)
Adequate intake is essential for optimal healing of peptic ulcers