Digestive diseases
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Digestive diseases. Main Characteristics. The digestive system is composed of:. Peptic Ulcers. Fig. 1. Fig. 2. Fig 1. From: http://digestive.niddk.nih.gov/ddiseases/pubs/hpylori/#5. Peptic Ulcers.

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Main characteristics
Main Characteristics

  • The digestive system is composed of:

Peptic ulcers
Peptic Ulcers

Fig. 1.

Fig. 2.

Fig 1. From: http://digestive.niddk.nih.gov/ddiseases/pubs/hpylori/#5

Peptic ulcers1
Peptic Ulcers

  • Ulcer- sore or lesion that forms in the lining of the stomach or duodenum where acid & pepsin are present

  • Ulcers in the stomach and duodenum are usually classified as peptic ulcers

Peptic ulcers2
Peptic Ulcers

  • Ulcers in the stomach

    • Gastric or stomach ulcers

  • Ulcers in duodenum

    • Duodenal ulcers

Common ulcer symptoms
Common Ulcer Symptoms

  • Most common: gnawing or burning pain in the abdomen between the breastbone and navel

  • Pain often occurs when stomach is empty: between meals & early morning

  • May last from a few minutes to a few hours

  • May be briefly relieved by eating or by taking antacids

  • Other less common: nausea & vomiting, loss of appetite, weight loss, bloating and burping

Other ulcer symptoms
Other Ulcer Symptoms

  • Emergency symptoms:

    • Bleeding in stomach & duodenum

      • If bleeding is heavy, blood will appear in vomit or stool

    • Sharp, sudden, persistent, stomach pain

    • May feel tired & week

Peptic ulcer epidemiology
Peptic Ulcer Epidemiology

  • Before 20th century, peptic ulcers were rare1

  • About 20 million Americans develop at least one ulcer during their lifetime

  • Peptic ulcer disease (PUD) is a common illness that affects >6 million persons in the United States each year2

  • A total of 1,453,892 first-listed PUD hospitalizations were estimated for 1998–2005

1. MajumdarD, Bebb J, Atherton J. Helicobacter infection and peptic ulcers. Medicine. 2010;30:3.

2. Sandler RS, Everhart JE, Donowitz M, Adams E, Cronin K, Goodman C, The burden of selected digestive diseases in the United States. Gastroenterology. 2002;122:1500–11. DOIPubMed

Peptic ulcer epidemiology1
Peptic Ulcer Epidemiology

  • Hospitalization rates were higher for adults ≥ 65 years of age and decreased with decreasing age group

    • Ulcers are rare in teenagers, more uncommon in children

  • Duodenal ulcers usually first occur between ages of 30-50 yrs. of age

    • Also occur more frequently in men than women

Peptic ulcer theories
Peptic Ulcer Theories

  • For almost a century: believed that ulcers were caused by lifestyle factors (e.g. stress, diet)

  • Later, discovered that ulcers were caused by imbalance between digestive fluids (HCl & pepsin) & stomach’s ability to defend itself against these

  • Current: Helicobacter pylori infection as the causative agent, non-steroidal anti-inflammatory drugs (NSAIDs), including aspirin and Ibuprofen

    • Lifestyle, acid & pepsin production play some role but not primary cause of most ulcers.

Helicobacter pylori infections
Helicobacter pylori Infections

  • Spiral shaped stomach bacterium

  • Bacteria + acid secretion damages stomach, duodenal tissue

    • Causes inflammation (gastritis) & ulcers

  • H. Pylori can survive in acidic stomach because it produces urease enzyme

    • Urease generates substances that neutralize the stomach’s acid

Helicobacter pylori infection
Helicobacter pylori Infection

H. pylori

H. Pylori in stomach

1 how h pylori produces ulcers
1. How H. pylori produces ulcers

  • Bacteria can penetrate stomach’s protective mucous lining because of shape & way they move

  • They produce substances the weaken stomach’s protective mucus & make the stomach cells more susceptible to the damage of acid & pepsin

2 how h pylori produces ulcers
2. How H. pylori produces ulcers

  • Bacteria can also attach to stomach cells further weakening the stomach’s defensive mechanisms & producing local inflammation

  • H. pylori can also stimulate the stomach to produce more acid (not understood why)

3 how h pylori produces ulcers
3. How H. pylori produces ulcers

  • Excess stomach acid & other irritating factors can cause inflammation of the duodenal bulb

  • In summary H. pylori induces gastritis through production of a variety of antigens, virulence factors, & soluble mediators

  • The bacterium deregulates, disarms & evades host immune responses to maintain chronic colonization of the gastric mucose

H pylori infection
H. Pylori infection

  • Within weeks of infection with H. pylori, many develop gastritis (inflammation of stomach lining)

  • However, most will never experience severe symptoms or problem related to the infection

  • Unclear why some people do and others do not develop H. pylori related symptoms or ulcers

Lifestyle factors implicated in ulcers
Lifestyle Factors Implicated in Ulcers

  • Cigarettes

    • Increase ulcer risk, slow rate of ulcer healing

  • Caffeine Foods

    • Can stimulate stomach acid secretion & aggravate ulcer pain

  • Alcohol Consumption

    • Ulcers more common in people with cirrhosis of liver

  • Emotional Stress

    • No longer thought to be cause of peptic ulcers, but emotional stress reported to increase ulcer pain

Nonsteroidal anti inflammatory drugs nsaids
Nonsteroidal anti-inflammatory drugs (NSAIDs)

  • Prescription of NSAID’s (arthritis treatment)

  • Non-prescription NSAID- aspirin, ibuprofen & naproxen

  • Interfere with stomach’s ability to produce mucus & bicarbonate

  • Affect blood flow to the stomach & cell repair

  • Ulcers usually disappear once person stops taking drug


  • Endoscopic Exams

  • X-ray examinations

  • Testing for H. pylori in blood, breath, & tissue samples


  • With medicines

    • H-2 blockers

    • Acid pump inhibitors

    • Mucosal protective agents

    • In H. pylori, these meds used in combination with antibiotics

  • Lifestyle changes

    • MDs used to advise avoidance of spicy, fatty, or acidic foods

  • Surgery

    • Usually last result if people don’t respond to meds or develop complications