Internal Medicine - Peptic Ulcers

Running head: INTERNAL MEDICINE 1
Internal Medicine
Name
Institutional Affiliation

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Introduction
Peptic ulcers are disease conditions which result in the breakage of the inner lining
mucosa of the stomach mainly, intestines, or even the lower parts of the esophagus. This disease
condition leads to the development of open sores in the duodenal and gastric mucosa, which then
extends further to the mucosa of the muscular. The stomach is where most of the ulcers occur
due to induction from drugs. There are abdominal pains that are experienced by an individual
having peptic ulcers. Most of the patients who are suffering from duodenal ulcers have been
reporting the pains, especially when the stomach is empty of food. About half the number of
patients undergo recurrence of the disease within a year when there is a stoppage of anti-ulcer
medication administration. There is more recurrence of the duodenal than gastric ulcers in most
westernized countries. The men present a large number of individuals who are suffering from
peptic ulcer disease as gender is concerned since it is more common in them (Bang et al., 2014).
Peptic ulcer disease pathophysiology
Pathophysiology of a disease is generally the abnormal effects or the deranged functions
which a disease may bring to human life. It involves an abnormal change in the biochemical
pathways, which could affect the overall functions of body systems. While discussing the peptic
ulcer disease pathophysiology, it is very important to consider heterogeneity. In clinical
diagnosis, gastrointestinal perforation or bleeding is presented together with erosions and acute
ulcers, which, when healed, the conditions cannot undergo recurrence easily. Factors dealing
with the defense of the mucosal lining are more considerably important than the aggressive
factors, which include pepsin and acid (Berg & McCallum, 2015). The gross lesion, which is
recognized here, is the local ischemia. Both the gastric and duodenal mucosa is probably more
vulnerable to these factors, which cause erosion.

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People having this condition have a destroyed and broken mucosal lining, which, when
exposed to acidic environments of the stomach, would cause a lot of pain. The wearing away of
the inner lining of these parts of the digestive system r by the digestive juices of the body (Lanas
& Chan, 2017). There is a very strong relationship between this disease and the use of Non –
Steroidal Anti – Inflammatory Drugs (NSAIDs), basing arguments on its causal agents.
Normally, there is always a thick protective layer that covers the lining of the stomach from the
destructive actions of the digestive enzymes, which may eventually lead to the development of
pores. It causes a lot of pain to the individual affected (Satoh et al., 2016).
The mucosal lining of the duodenum and the stomach is normally protected from the
actions presented by the digestive acids and pepsin through the following adjustments: mucus
secretion, bicarbonate production, the normal flow of blood which helps in removing the excess
acids and finally through the repair of the injured epithelial cell through its rapid renewal. A
peptic ulcer is, therefore, a condition that presents itself when there is the destruction of the
normal mechanisms of repair and defense. For asymptomatic ulcers to develop, there must be
more than one malfunction of these mechanisms (Kuna et al., 2019).
Evidence of repair processes and chronic inflammation surrounding lesions are typically
shown with peptic ulcers. There are emergency situations that can be brought during this
condition; therefore, it would require immediate response failure to which more and more
problematic situations can be incurred. An intense occurrence of severe pain in the abdominal
region, whether accompanied by bleeding evidence or not, is a clear indication of the ulcer
perforation in the digestive system, especially in the duodenum and the stomach. Serious
bleeding can also be indicated by vomit that looks like coffee grounds or the presence of stools
with black tarry (Bonamin et al., 2014).

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Peptic ulcers occur mainly in two regions of the body those are duodenal and gastric. A
peptic ulcer which is not much complicated is presented with similar signs like those which are
produced by dyspepsia and that of gastritis. Perforation and hemorrhage are complications with
the stomach, including the intestines, which significantly contribute to the mortality and
morbidity of peptic ulcers. Perforation of the ulcers can occur and spread even to neighboring
organs, for example, the pancreas (Rezaei et al., 2014).
Causes of peptic ulcer disease
There are primary factors that lead to the occurrences of peptic ulcers. These are the
factors which, when encountered during the daily life of a person, leads to the development of
peptic ulcer condition or disease. These include the use of nor-steroidal anti-inflammatory drugs

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given the short form as NSAIDs, especially the aspirin, bacterial infection majorly caused by the
Helicobacter pylori, which destroys the mucosal lining of the stomach, gastritis, and stress
(Carucci, 2015). Ulcers can be induced by stress conditions which an individual may have been
going through. The use of very concentrated solutions of ethanol or the use of this solution in
excessive amounts contributes to the destruction of the gastric mucosa leading to great damages,
which can really bring very many problems with a lot of difficulties of being solved. This can
ultimately make the symptomatic conditions of peptic ulcers worsen, thereby interfering with the
normal healing of this condition even if medications that are appropriate are administered.
Alcoholic beverages with modest doses, when used by healthy people, do not appear to cause
conditions of peptic ulcers (Ryu et al., 2015). It is shown that there are instances of increased
gastric secretions due to the consumption of both beer and wines. On the other hand,
consumptions of low concentrated ethanol are not likely to cause an increased gastric secretion.
Bicarbonate secretion is reduced and may be completely decreased due to the consumption of
products from the tobacco plant. This eventually leads to reduced blood flow in the mucosa then
leads to the exacerbation of inflammation. All these situations are closely associated and related
to very many additional complicated effects of H. pylori infections (Iijima, 2014).
Due to the improved health care systems which involve the management of this
condition, the incidences of this disease have greatly reduced markedly of the last 30 years. This
has involved the early screening of the bacteria involved and the recognition of the various risk
factors and the symptoms involved with peptic ulcer condition. This has led to decreased
instances of surgeries that are performed during therapies and diagnosis done on this condition
for the past three decades. There are other risk factors that are involved with peptic ulcer
conditions, and they include the following: Zollinger – Ellison syndrome, use of products from

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tobacco, gastrinoma, alcohol, non – steroidal anti-inflammatory drugs and aspirin (Prabhu &
Shivani, 2014). Apart from the major causes of the peptic ulcer, which are the Helicobacter
pylori and NSAIDs, there is a minor cause, which is Zollinger- Ellison syndrome. This syndrome
is associated with the overproduction and over secretion of gastrin hormone, which causes the
production of excess acids in large amounts, which is previously caused by original occurrences
of tumors of the pancreas or the duodenum. The occurrences of these tumors over and over again
lead to the recurrences of instances of ulcers. These tumors must, therefore, be removed
whenever they occur because they are usually malignant in nature. This will decrease the
production of acids to a greater level hence helps in the management of this condition (Oppong
et al., 2015).
Even though most ulcers involve the action of the bacterium Helicobacter pylori or the
NSAIDs when used, quite a number of ulcer cases are produced by other reasons, which also
depends on a particular person. The effects caused by these other reasons may increase an
individual's vulnerability to the effects which can be caused by causative agents of peptic ulcers.
Emotional stress is one of the other reasons which can lead to the development of a peptic ulcer.
Even though emotional stress is not believed and known to cause peptic ulcers, it has great
negative effects on the physiological processes the behaviors of a person leading to induction of
vulnerability to contracting peptic ulcer (Levenstein et al., 2015). This effect varies from one
person to another and can lead to the different physiological responses, for example, that of
emptying of the stomach hence leading to an increased load of acid in the duodenum. Stress can
also lead to an impaired process of the healing of wounds and increased incidence of secretion of
pepsin and acid. Stress is also found to be causing many behavioral changes. These behaviors
include excessive use of alcohol, non-steroidal anti-inflammatory drugs, and cigarettes. All these

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behaviors increase the chances of an individual's risks of getting peptic ulcers. Stress, therefore,
can be said to be contributing to the development of ulcers even though its exact causative
effects are not yet known and fully understood (Melinder et al., 2015).
Symptoms of peptic ulcer disease
A peptic ulcer is accompanied by abdominal pains. This is shown by most of the patients
who are suffering from duodenal ulcers who have reported the pains, especially when the
stomach is empty of food. There are gastrointestinal perforation or bleeding, which are presented
together with erosions and acute ulcers. Serious bleeding can also be indicated by vomit that
looks like coffee grounds or the presence of stools with black tarry. This leads to a characteristic
black stool, which is also dark in color (Kavitt et al., 2019).
For mild peptic ulcers, there is the presence of burning pain in the middle parts of the
stomach or the upper parts mostly between the meals, including during the nights. Bloating is
also evidenced by people suffering from peptic ulcers. There are also instances of heartburn,
which occurs mostly to people with gastric ulcers. A peptic ulcer is also characterized by
abdominal pain and discomfort, together with weight loss, vomiting which is likely to be bloody,
anorexia, chest pains, nausea, and fatigue (Coblijn et al., 2016).
Treatment of peptic ulcers
The first line of focus for the treatment of peptic ulcers is that which aims at eradicating
the primary cause of the disease. This involves the elimination of the bacterium Helicobacter
pylori, which is the main causative organism for this condition. It involves the use of two or even
more antibiotics plus medication for acid suppression. This can be supplemented again with
surgical interventions where there are complications related to this bacterium. Interventions for

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this bacterium can also involve procedures for the endoscopic, laparoscopic, and those of open
for treating each lesion to selective vagotomies and partial gastrectomy (Buzás & Supuran,
2015).
The second way in which peptic ulcer is managed and treated is through the use of drug
therapies for providing interventions. These drugs include antacids, sucralfate, H2 – receptor
blockers, antibiotics like amoxicillin, tetracycline, bismuth, proton pump inhibitors, misoprostol,
among others. These mainly aim to relieve pain, prevent a recurrence, and promote healing
(Lagoo et al., 2014).
Another way in which this condition is managed is through the interaction of the drug
with nutrition. This is due to the fact that some medications are used to induce nutritive effects
that are responsible for the treatment. A good example is antacids like aluminum hydroxide,
which has a gastrointestinal effect of increasing iron and folate, which causes hypophosphatemia
metabolic effects (Choudhary et al., 2016).
Another treatment therapy is the nutritional, medical therapy where it is advised that there
should be a decreased consumption of spices like red peppers, coffee & caffeine, increased
consumption of omega-3 and omega- 6 fatty acids having a protective effect, decreased
consumption of alcohol thereby helping to manage the bacterium complications. There are also
other herbs that are undergoing research, for example, aloe vera, guarana, among others, which
can help eradicate the bacterium (Huang et al., 2015).

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Conclusion
Peptic ulcer disease is a serious condition that has great negative effects on the digestive
system at large. This brings many complications to the inner mucosal lining of the
gastrointestinal tract, therefore, leads to the destruction of the thick mucus lining, which protects
the wall lining from the digestive enzymes. Due to the great health risks involved when an
individual possesses this condition, appropriate measures need to be arrived at to enhance the
management of this condition. These measures include the use of appropriate treatment methods
to help in controlling the bacterium, which causes this disease. Nutritive and lifestyle measures
should also be taken into consideration to help in the management of peptic ulcer related health
effects.

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