Medicine Review: Peptic Ulcer Disease

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MEDICINE REVIEW: PEPTIC ULCER DISEASE

BY: HARIZ HIZAMI HATTA

1.      Defence mechanism of the stomach layers


a)      Mucous secretion

·         Function as protective barrier of stomach epithelium by covering it with thick surface mucous layer to prevent direct contact of gastric acidity to the stomach cells

 

b)      Bicarbonate ion secretion

·         Protecting the gastric mucosa by neutralizing the gastric acid

 

c)      Mucosal blood flow regulation

·         This regulation will ensure oxygen and nutrients are provided to the gastric mucosa and help the ability to recover from damage by regeneration

 

d)      Apical membrane transporters (pH balance)

·         Adjust the electrolyte balance and pH balance which ensure gastric mucosal stability

 

e)      Regenerating capacity of stomach epithelium

·         Ensure proper recovery of epithelial layer from damage for optimum functioning

 

f)       Prostaglandin secretion

·         Control the acid secretion

·         Increasing mucous and bicarbonate production

·         Increasing the mucosal blood flow

·         Inhibiting the gastric motility

 

2.      Definition of Peptic Ulcer Disease

·         Chronic mucosal ulceration affecting the lining of duodenum (duodenal ulcer) or stomach (gastric ulcer)

 

 

3.      Causes of Peptic Ulcer Disease

 

a)      H. pylori infection

·         Increase in gastric acid and pepsin production result from inflammatory response to toxin released

·         Reduces bicarbonate ion secretion

·         Causes epithelial cell injury and inflammation

·         Thrombotic occlusion of capillaries by platelet activating factor will impair the blood flow

·         Overall: decrease gastroprotective mechanism

 

b)      Gastrinoma

·         Neoplastic cells increase the gastric acid production

 

c)      Prolong Use of Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

·         Inhibition of COX-1 inhibition leading to decrease prostaglandin secretion. Then result in increased acid production and decrease gastric mucous secretion

·         NSAIDs can also be toxic to gastric epithelial cells

 

d)      Cigarette smoking

·         Impairment of blood flow, causing oxygen and bicarbonate ion cannot have distributed properly for protection. Epithelial cells unable to regenerate optimally

 

All of the above degenerative mechanism lead to erosion of the mucosal layer and eventually cause bleeding to the stomach or duodenal layer (ulcer).

 

4.      Signs and Symptoms of Peptic Ulcer Disease

a)      Epigastric pain and dyspepsia (irritation of somatic innervation)

b)      Nausea, vomiting, bloating, belching

c)      Melena; pass of black, tarry and bloody stool (from upper GI bleed)

d)      Coffee-ground emesis (blood moves back into the oesophagus)

                  e)    Hematemesis (vomiting blood d/t oesophageal bleeding

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