Definition
Peptic ulcers are defects in the gastric or duodenal mucosa that penetrate through the muscularis mucosae due to acid and pepsin-related injury. They differ from erosive gastritis, which involves superficial inflammation without mucosal penetration.They could develop into an ulcer.
Etiology / Risk Factors
- Helicobacter pylori infection (most common cause)
- NSAIDs / Aspirin use
- NSAID ulcers can be silent, but complications can be life-threatening
- Smoking → impairs mucosal healing
- Age > 60, previous history of ulcer
- Stress, alcohol, Zollinger-Ellison syndrome (rare)
Pathogenesis
- Disruption of mucosal defense due to acid + pepsin
- H. pylori damages mucosa → inflammation + ulceration
- NSAIDs inhibit prostaglandins → ↓ mucosal blood flow & mucus → ulcer formation
- Ulcers penetrate beyond mucosa (unlike gastritis) → into submucosa or muscularis
Symptoms / Clinical Manifestations
- Burning or gnawing epigastric pain:
- Duodenal ulcer: pain improves with eating, returns 2–3h after meals
- Gastric ulcer: pain may worsen with eating
- Nausea, bloating, early satiety
- Weight loss (more common with gastric ulcer)
- Nighttime pain may awaken the patient
- Occult bleeding, anemia
- Sometimes asymptomatic until complications