Duodenum and Stomach Ulcers Essay 2022

Running head: PEPTIC ULCERS 1
Duodenum and Stomach Ulcers
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Introduction
A peptic ulcer in adults is a common disease that is affecting millions of people around
the globe. A peptic ulcer is a type of infection that involves the development of open sores on the
upper side of the small intestine, lower oesophagus and inside the lining of the stomach. It
mainly affects the inner lining of the duodenum, stomach, and oesophagus. The most common
symptom associated with a peptic ulcer is a stomach pain. This results when the stomach acids
etch away the digestive protective layer of mucus of a person. Peptic ulcer differentiates with an
erosion since it incorporates a deeper extension into the affected parts lining and incites an extra
inflammatory reaction from the involved tissues and occasionally with a scaring (Lanas & Chan,
2017). This essay aims to discuss the pathophysiology, causes, symptoms, and treatment of
peptic ulcer disease.
Pathophysiology
The most important contemplation while evaluating the pathophysiology of peptic ulcer
disease is the heterogeneity. The present clinical erosions and acute ulcers are associated with
perforations and gastrointestinal bleeding. There is no re-occurrence of these complications after
healing. The most important factors to consider while dealing with gastrointestinal bleeding and
perforations are the mucosal defense than the destructive factors like the pepsin and acid. The
vulnerability of the gastric mucosal and duodenal mucosa is the same (Berg & McCallum, 2016).
The true recurrent or chronic peptic ulcers that occur in the muscularis mucosae are
responsible for the abdominal pain. Most of the patients with duodenal ulcer complain of pain
when their stomach is relieved by food or when it’s empty. This is followed by several relative
patterns for long periods that are free from symptoms in between the recurrence. The abdominal

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pain recurrence is experienced by 50% of patients of peptic ulcer disease within a year after they
have stopped taking anti-ulcer medications. Recent research has shown that peptic ulcer disease
is more common in men than women. In addition, several studies have shown that familial and
genetic factors in duodenal ulcers increase acid-pepsin production in response to a number of
stimuli (Søreide, 2016).
The etiology of this disease remains unclear, despite much research that has been
conducted towards its pathophysiology. The ulceration differences between individuals are noted
due to the multiple processes that control the secretion of pepsin and acid in the digestive tract,
repair of the gastrointestinal mucosa, and defense. The majority of the gastric ulcers and a
substantial number of duodenal ulcers are not related to the increased secretion gastric acid. The
non-steroidal anti-inflammatory drugs (NSAIDs) cause a significant amount of duodenal and
gastric ulcers. This possibly is a result of inhibition of the production of prostaglandin due to the
loss of its protective effects. The absence of gastrinoma and NSAIDs leads to all the duodenal
ulcers and gastric ulcers occurring in a setting of H. pylori infection. Evidence support that H.
pylori are vital ingredients towards the ulcerative process, just like pepsin and acid (Tsukanov et
al., 2017).
Although the pathophysiology of the duodenal and gastric ulcers is the same, there exists
a clear difference between the two. The duodenal ulcer is characterized by duodenitis, H. Pylori
infection, and in most cases, when peptic and acid activity is moderately increased by the
impaired secretion of the duodenal bicarbonate. The fact remains that the increased peptic action,
together with the reduced duodenal protecting capacity, can lead to more mucosal injury and
cause gastric metaplasia. The infection and inflammation disrupt the mucosal process of defense

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or regeneration and results in ulceration. The sequence of injuries and inflammation leads to loss
of regeneration framework and thus causing chronic ulcers (Seo et al., 2016).
Source; https://www.medicinenet.com/peptic_ulcer/article.htm
Causes
Peptic ulcer occurs when the acid of the digestive system erodes the inner membranes of
the small intestines and that of the stomach. This leaves behind open painful sores that may lead
to bleeding. There is a mucosa layer on the inner side of the digestive tract that protects it against
erosion by the acid. An ulcer will develop when the amount of the mucus is outdone by the
increased amount of acid within the digestive tract (Satoh et al., 2016). Some of the common
causes of peptic ulcer disease are discussed below.
A Bacterium
The helicobacter pylori (H. pylori) bacteria live in the mucosa layer that protects and
covers tissues that line the small intestine and the stomach. H. pylori cause no problems in the

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stomach lining, but it may cause inflammation on the inner layer of the stomach leading to an
ulcer. The H. pylori infection may be transmitted from one person to another through close
contact like kissing. One also can contract H. pylori through water and food (Zatorski, 2017).
Regular use of particular pain killers
Frequent use of pain relievers like aspirin, certain over-counter painkillers, and some
prescribed pain medications known as non-steroidal anti-inflammatory drugs can cause
inflammation or irritate the stomach lining and the small intestine. The NSAIDs medications
include; ibrufen (Advil, Motrin B and other), ketoprofen, naproxen sodium (Aleve, Anaprox),
and others. Peptic ulcer disease is more common in older adults than youths because they use
pain medications more regularly. Some take pain relievers mostly to relieve osteoarthritis pains
(Shim & Kim, 2016).
Other medications
Taking of other medicines such as anticoagulants, selective serotonin reuptake inhibitors
(SSRIs), risedronate, low dosage of aspirin, and alendronate can facilitate the increase of chances
of peptic ulcer development (Lanas & Chan, 2017).
Symptoms
Stomach ulcers
The pain in the stomach is the main symptom associated with peptic ulcer disease (PUD).
The pain associated with PUD usually correlates poorly with the severity or presence of active
ulceration. Some people may experience pain despite their condition being entirely healed by the
use of medication. Others do not experience pain at all. In so many circumstances, ulcers usually

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come and go spontaneously without a person noticing that they have them. This goes on until
serious complications like perforation and bleeding occur. Hence, the symptoms of PUD varies
from one person to another. Since some individuals with peptic ulcers do not have symptoms
while others may experience a few or several (Lee, Sung, Kim, Lee, Park & Shim, 2017).
The burning or dull pain in the stomach indicates the onset of PUD. The pain may be
experienced anywhere between the breastbone and the belly button. Pain associated with a peptic
ulcer may include the following aspects;
• Can last for hours or sometimes minutes
• Can come and end for numerous months, days or weeks
• Can stop for a short time after the intake of antacids
• Is typically experienced when the stomach is empty, for instance, during the night or
between meals
• The pain often gets worse early in the morning and at night
• The peptic ulcer pain can feel like gnawing or burning, and it may go through the back
Duodenum ulcers
Peptic ulcers have also been linked to bleeding in the duodenum. Bleeding can also be
the only symptom of the ulcer. This bleeding can be slow or fast. Fast bleeding as a result of
PUD manifests itself in one of the following manners (Magsi, Iqbal, Malik & Parveen ,2017);
• Presence of blood in the stool or having a black, tarry, stick looking stools

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• Vomiting of a dark material that looks something corresponding coffee grounds or
vomiting blood. This should be treated as an emergency and warrants a quick visit to the
emergency department
Slow bleeding in most situations is hard to detect since it does not reveal dramatic results
• The usual result decreased blood cell count (anaemia)
• The symptoms of anaemia are lack of energy, pale skin (pallor), rapid heartbeat
(tachycardia), weakness, and tiredness (fatigue) (Al Yassin, Fatakhova, Al-Naqeeb, Haggerty &
Tofano, 2019).
Other symptoms
Other peptic ulcers symptoms that are less experienced include;
• Burping
• Poor appetite
• Bloating
• Vomiting
• Weight loss
• Feeling sick and uncomfortable in the stomach
• If severe, the condition causes a hole in the wall of the stomach
Treatments

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The main reasons for treating PUD is to help in healing the condition, relieve pain, and
support in preventing complications. The initial step in the treatment of PUD incorporates
decreasing the risk factors and then medications. Some of the methods that can help in treating
PUD include;
Use of medications
If the doctor understands the cause of the ulcer, they may treat it by removing the cause.
For instance, if the cause is nonsteroidal anti-inflammatory drugs (NSAIDS), the treatment can
include changing the painkiller. Once the removal of the cause has been conducted, the doctor
continues to undertake the treatment by treating the symptoms of the peptic ulcer (Kavitt,
Lipowska, Anyane-Yeboa & Gralnek, 2019). Drugs that can be prescribed include;
• Proton pump inhibitors (PPI) that can support in blocking cells that produce acid
• The histamine blockers (H2-blockers) which help in preventing the stomach from
producing excess acid
• Pepto-Bismol that helps in protecting the lining
• Alginate or antacids that supports in neutralising the level of acids existing in the
stomach. Antacids that are considered effective and safe include Amphojel, Mylanta, and
Maalox (Sałaga & Mosińska, 2017).
Effective treatment for peptic ulcers needs a combination of several antibiotics,
sometimes in combination with a PPI or Pepto-Bismol. After the treatment, most of the
symptoms usually subside quickly (Scally et al., 2018). However, the treatment ought to be
continued, especially if the peptic ulcer disease is as a result of infection by H. pylori. This is

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because it is challenging to completely eradicate the H. Pylori (Narayanan, Reddy & Marsicano,
2018).
Surgical treatments
In some instances, surgery may be the best option to help treat peptic ulcer disease. Such
situations include if the ulcer is bleeding, is not healing, continues to return, or blocks the act of
food leaving the stomach. Surgery helps in treating peptic ulcer disease by achieving the
following:
• Cutting the nerve that is involved in the production of acid in the stomach
• Removal of the ulcer
• Tying off the blood vessels that are bleeding
• Sewing tissue from another site onto the ulcer (Tsai & Brooks, 2019).
Lifestyle option
They include the incorporation of specific diets, stopping the use of alcohol, and stopping
smoking. Quitting smoking will help to decrease stomach acid since smoking affects the
protective lining of the stomach, making the stomach more vulnerable to the occurrence of an
ulcer. While stopping the use of alcohol is essential since excessive usage of alcohol can erode
and irritate the mucous lining in the intestines and stomach, causing bleeding and inflammation.
These treatment options should be used in combination with other treatment plans like surgery
and the use of medications. Example of essential diets are;
• Vegetables and fruits. They help in inhibiting the secretion of acid, rich in antioxidants
and contain anti-inflammatory and cytoprotective properties

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• Vitamin C. It is a powerful antioxidant that supports in eradicating H. pylori
• Zinc. Helps in healing wounds and in maintaining a healthy immune system
• Selenium. This decreases the risk of infection complications and can also promote
healing
• Probiotics. These types of foods contain active bacterial content, such as probiotic
yoghurt. They support in reducing H. pylori infection (Satoh et al., 2016).
Conclusion
This essay has analyzed, evaluated, and discussed the causes, pathophysiology, treatment,
and symptoms of peptic ulcer disease. The disease affects the digestive system, particularly the
small intestine and stomach. In the pathophysiology of the peptic ulcer disease, the acid in the
digestive tract “eats away” the lining of the stomach leaving behind excruciating sores that may
even bleed. This result, whereby the acid produced by the digestive tract, is more than the mucus
that covers and protects the stomach lining against the acid. The paper has also discussed some
of the causes of the disease, which include frequent use of certain pain relievers, H. bacterium,
and the use of other medications like aspirin and anticoagulants. The essay has also described the
treatments that can be used to treat peptic ulcer disease and demonstrated the signs and
symptoms of the disease. Some of the signs and symptoms of the disease discussed in this paper
are a pain in the stomach and bleeding in the intestines and the stomach. Treatments of peptic
ulcer disease include surgical, medication, and lifestyle moderation.

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References
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