Pathophysiology
Eighty percent of all peptic ulcer disease is caused by Helicobacter pylori (H. pylori) infection that causes
inflammation and erosion of the mucosal barrier in the stomach.
Gastric mucus provides a physical and chemical barrier, protecting the epithelial cells lining the
stomach and trapping bicarbonate between the mucus and the cells.
Hydrogen production outpaces bicarbonate production during physiologic or psychological
stress.
Common gastric irritants or contributors to gastritis include alcohol, stress, tobacco, NSAIDs,
H. pylori bacteria, and shock.
Assessment and Diagnostic Findings
Duodenal ulcer: Midepigastric pain 2–4 hours after meals, relieved with food intake.
Gastric ulcer: Left epigastric pain that increases with food intake, especially 1–2 hours after meals; hematemesis is more common than melena.
Urea breath test, IgG antibody test for H. pylori, H. pylori culture, barium swallow with x-ray, EGD.
Complications
Bleeding, anemia, perforation with peritonitis or pancreatitis (severe back pain) or obstruction (pyloric scarring), upper gastrointestinal (GI) bleed.
Gastric cancer (chronic irritation and regeneration of cells).
Dumping syndrome after subtotal gastrectomy.
Medical Care and Surgical Treatment
Antibiotics, proton pump inhibitors, H2 blockers, coating agents, antacids.
Vagotomy.
Subtotal gastrectomy.
Keep in Mind
Avoid spicy foods, alcohol, tobacco, and caffeine; manage stress; eat small, frequent bland meals.
Eighty percent of all peptic ulcer disease is caused by Helicobacter pylori (H. pylori) infection that causes
inflammation and erosion of the mucosal barrier in the stomach.
Gastric mucus provides a physical and chemical barrier, protecting the epithelial cells lining the
stomach and trapping bicarbonate between the mucus and the cells.
Hydrogen production outpaces bicarbonate production during physiologic or psychological
stress.
Common gastric irritants or contributors to gastritis include alcohol, stress, tobacco, NSAIDs,
H. pylori bacteria, and shock.
Assessment and Diagnostic Findings
Duodenal ulcer: Midepigastric pain 2–4 hours after meals, relieved with food intake.
Gastric ulcer: Left epigastric pain that increases with food intake, especially 1–2 hours after meals; hematemesis is more common than melena.
Urea breath test, IgG antibody test for H. pylori, H. pylori culture, barium swallow with x-ray, EGD.
Complications
Bleeding, anemia, perforation with peritonitis or pancreatitis (severe back pain) or obstruction (pyloric scarring), upper gastrointestinal (GI) bleed.
Gastric cancer (chronic irritation and regeneration of cells).
Dumping syndrome after subtotal gastrectomy.
Medical Care and Surgical Treatment
Antibiotics, proton pump inhibitors, H2 blockers, coating agents, antacids.
Vagotomy.
Subtotal gastrectomy.
Keep in Mind
Avoid spicy foods, alcohol, tobacco, and caffeine; manage stress; eat small, frequent bland meals.