Peptic ulcer disease (PUD) is a break in the lining of the stomach, first part of the small intestine, or

occasionally the lower esophagus. An ulcer in the stomach is known as a gastric ulcer while that in the
first part of the intestines is known as a duodenal ulcer.

❖ Types of peptic ulcer

I. Gastric ulcer
II. Duodenal ulcer
❖ Causes of peptic ulcer
1) H. pylori
A major causative factor is chronic inflammation due to Helicobacter pylori . The immune
system is unable to clear the infection, despite the appearance of antibodies. Thus, the
bacterium can cause a chronic active gastritis. stimulates to production of gastric acid the
increase in acid can contribute to the erosion of the mucosa and therefore ulcer formation.
2) NSAIDs (non steroidal anti-inflammatory drugs)
Another major cause is the use of NSAIDs, such as ibuprofen and aspirin.
3) Stress
Stress due to serious health problems such as chronic life stress was once believed to be the
main cause of ulcers,
4) Diet
Dietary factors such as spice consumption, increases risk when associated with H.
pylori infection.
5) Smoking and alcohol consumption
❖ Clinical manifestation of peptic ulcer
Signs and symptoms of a peptic ulcer can include one or more of the following:
a) Abdominal Pain, classically epigastric strongly correlated to mealtimes. In case of duodenal
ulcers the pain appears about three hours after taking a meal
b) Bloating and abdominal fullness
c) Water brash (rush of saliva after an episode of regurgitation to dilute the acid in esophagus
d) Nausea, and copious vomiting
e) Loss of Appetite and weight loss
f) Hematemesis (vomiting of blood); this can occur due to bleeding directly from a gastric ulcer,
or from damage to the esophagus from severe/continuing vomiting.
g) Melena (tarry, foul-smelling feces due to presence of oxidized iron from hemoglobin)
h) Peritonitis. rarely, an ulcer can lead to a gastric or duodenal perforation, which leads to acute
peritonitis, extreme, stabbing pain and requires immediate surgery.
✓ Differences between gastric and duodenal ulcer

Difference Gastric Ulcer Duodenal Ulcer

Site generally middle two-third of lesser cure Generally duodenal bulb
Pain 15-30 minutes after meals, relieved by vomiting Relieved by meal
Gastric Acid Normal or low Raised
Vomiting common common
Weight Loss Gain
Complication Malignant tumor Never

✓ Diagnosis test for peptic ulcer

• Medical history
• Physical examination
• Clinical manifestation
• Endoscopy such as:
 Laboratory tests for H. pylori. look for H. pylori using a blood, stool or breath test.

 Endoscopy. use a scope to examine your upper digestive system (endoscopy). During
endoscopy, passes a hollow tube equipped with a lens (endoscope) down throat and into
esophagus, stomach and small intestine. Using the endoscope, for looks of ulcers. when
detects an ulcer, small tissue samples (biopsy) may be removed for examination in a lab.
A biopsy can also identify whether H. pylori is in stomach lining.
 Upper gastrointestinal series. Sometimes called a barium swallow, this series of X-rays
of upper digestive system creates images of esophagus, stomach and small intestine.

❖ Treatment of peptic ulcer disease

1- medical treatment
▪ Acid reducing medication
H2 antagonists or proton-pump inhibitors decrease the amount of acid in the stomach,
helping with healing of ulcers.
▪ H. pylori
When H. pylori infection is present, the most effective treatments are combinations of 2
antibiotics (e.g. clarithromycin, amoxicillin, tetracycline, metronidazole) and a proton-
pump inhibitor (PPI), In complicated, treatment-resistant cases, 3 antibiotics (e.g.
amoxicillin + clarithromycin + metronidazole)
 2- Surgery

▪ Perforated peptic ulcer is a surgical emergency and requires surgical repair of the
perforation. Most bleeding ulcers require endoscopy urgently to stop bleeding
with cautery,

❖ Complications of peptic ulcer

1. Change of body weight
2. Bleeding
3. Anemia
4. Perforation
5. Penetration
6. Gastric obstruction

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