Internal Medicine (Theory) · MU Sofia

33. Stomach and Duodenal Ulcers

Explains how peptic ulcers in the stomach and duodenum form, distinguishing them from erosive gastritis, and lists risk factors such as H. pylori infection, NSAID use and smoking. Covers the pathogenesis, the differing pain patterns of gastric and duodenal ulcers, diagnostic options including urea breath testing and gastroscopy, and drug and lifestyle treatment. Ends with the main complications: haemorrhage, perforation, gastric outlet obstruction and malignant change.

Inside: 8 sections · 4 labelled pictures · 14 flashcards · 2 min

Topic 31 of 58 in the MU Sofia syllabus for Internal Medicine (Theory) (Medicine, Year 3). The free AceMed note covers it in 8 sections, about 314 words (2 min of reading), with 14 flashcards.

In this note

  1. Gastric and Duodenal Ulcers
  2. Definition
  3. Etiology / Risk Factors
  4. Pathogenesis
  5. Symptoms / Clinical Manifestations
  6. Diagnosis
  7. Laboratory & Instrumental
  8. Treatment

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

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