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PATHOPHYSIOLOGY OF

GASTRITIS AND PEPTICULCER

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Pathophysiology of Gastritis

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Gastritis Can be classified as:

  Acute

  Chronic

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Acute Gastritis

Erosive Medications

  Alcohol

  Cocaine

  Stress

  Radiation

  Bile reflux  Ischemia

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Acute Gastritis

Bacterial  Helicobacter pylori 

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Chronic Gastritis

 H pyloriassociated chronic gastritis 

Infectious granulomatous gastritis

Gastritis in patients who are immunosuppressed

Autoimmune gastritis

Chronic reactive chemical gastropathy Chronic noninfectious granulomatous gastritis

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Pathophysiology of Peptic Ulcer

Disease (PUD)

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Definition:

A peptic ulcer, sometimes called a stomach ulcer, is a

sore that forms in the lining of the stomach or of the

duodenum Deeper than just mucosa

Gastric ulcer

Duodenal ulcer

Together, ulcers of the stomach and duodenum

are referred to as peptic ulcers.

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Anatomy of stomach and duodenum

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Anatomy of stomach and duodenum

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� Mucous cells in the gastric

pits secrete mucus

parietal cells secrete

hydrochloric acid

G cells, which are present

predominantly only in the

antrum of the stomach,

secrete gastrin

chief cells secrete

pepsinogen

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Production of acid in stomach

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DEFENSE SYSTEM OF STOMACH AND DUODENUM

The mucous layer, which coats the stomach and duodenum,

forms the first line of defense.

Bicarbonate, which the mucous layer secretes, neutralizes the

digestive acids.

Hormone-like substances called prostaglandins help keep the

blood vessels in the stomach dilated, ensuring good blood flow

and protecting against injury. (Prostaglandins are also believed

to stimulate bicarbonate and mucus production.)

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Normal

Increased attackHyperacidity

Weak defenseHelicobacter pyloriStress, smoking, drugs

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GENERAL SYMPTOMS OF PEPTIC ULCER

� Pain in the upper abdomen below the sternum(breastbone) that comes and goes.

� It may occur most before meal or when you are hungry

� Other symptoms:

Bloating, dyspepsia, nausea, vomiting, poor appetite,

weight loss, burping (belching)

� Complication:

Bleeding from ulcer 

Perforation

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COMPLICATIONS: Bleeding

Fibrosis, Stricture obstruction pyloric

stenosis.

Perforation Peritonitis- emergency.

Gastric carcinoma.

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Etiology:

Helicobacter pylori infection(90%).

Drugs - anti-inflammatory (NSAIDs) & Corticosteroids.

Hyperacidity - eg. Zollinger Ellison syndrome.

Cigarette smoking, Alcohol

Stress

Coffee

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MORPHOLOGY

Spiral shaped and multipollar

flagella

H pylori is a gramnegative rod

about 3.5 micrometers long and

0.6 micrometers wide that

thrives at 37°C (98.6°F) in

a neutral medium.

Corckscrew motivation

Micreaerophile

Producing Urease

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Helicobacter pylori:

Most common infection in the world

H.pylori related disorders:

  Chronic gastritis 90%  Peptic ulcer disease 95-100%

  Gastric carcinoma

  Reflux Oesophagitis (GERD)

  Non ulcer dyspepsia

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PATHOGENESIS

Optimum pH 6-7

Lumen of stomach is with pH of 1-2

Live in deeper parts under lumen where pH is 7.4

Urease reduce the acidity of stomach

Protease Mucous break down.

Cytotoxine (vacoulating gene{Vac A},

Cytotoxin-associated gene{Cag A})

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Helicoba

cter pylori

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Complications of Peptic Ulcers

Haemorrhage

Perforation

Pyloric Stenosis

Development of malignant tumor