1. DIGESTIVE DISEASES

2. Main Characteristics  The digestive system is composed of:

3. Peptic Ulcers Fig 1. From: http://digestive.niddk.nih.gov/ddiseases/pubs/hpylori/#5 Fig. 1.Fig. 2.

4. Peptic Ulcers  Ulcer- sore or lesion that forms in the lining of the stomach or duodenum where acid & pepsin are present  Ulcers in the stomach and duodenum are usually classified as peptic ulcers

5. Peptic Ulcers  Ulcers in the stomach  Gastric or stomach ulcers  Ulcers in duodenum  Duodenal ulcers

6. Common Ulcer Symptoms  Most common: gnawing or burning pain in the abdomen between the breastbone and navel  Pain often occurs when stomach is empty: between meals & early morning  May last from a few minutes to a few hours  May be briefly relieved by eating or by taking antacids  Other less common: nausea & vomiting, loss of appetite, weight loss, bloating and burping

7. Other Ulcer Symptoms  Emergency symptoms:  Bleeding in stomach & duodenum If bleeding is heavy, blood will appear in vomit or stool  Sharp, sudden, persistent, stomach pain  May feel tired & week

8. Peptic Ulcer Epidemiology  Before 20 th century, peptic ulcers were rare 1  About 20 million Americans develop at least one ulcer during their lifetime  Peptic ulcer disease (PUD) is a common illness that affects >6 million persons in the United States each year 2  A total of 1,453,892 first-listed PUD hospitalizations were estimated for 1998–2005 1. Majumdar D, Bebb J, Atherton J. Helicobacter infection and peptic ulcers. Medicine. 2010;30:3. 2. Sandler RS, Everhart JE, Donowitz M, Adams E, Cronin K, Goodman C, The burden of selected digestive diseases in the United States. Gastroenterology. 2002;122:1500–11. DOIPubMed

9. Peptic Ulcer Epidemiology  Hospitalization rates were higher for adults ≥ 65 years of age and decreased with decreasing age group  Ulcers are rare in teenagers, more uncommon in children  Duodenal ulcers usually first occur between ages of 30-50 yrs. of age  Also occur more frequently in men than women

10. Peptic Ulcer Theories  For almost a century: believed that ulcers were caused by lifestyle factors (e.g. stress, diet)  Later, discovered that ulcers were caused by imbalance between digestive fluids (HCl & pepsin) & stomach’s ability to defend itself against these  Current: Helicobacter pylori infection as the causative agent, non-steroidal anti-inflammatory drugs (NSAIDs), including aspirin and Ibuprofen  Lifestyle, acid & pepsin production play some role but not primary cause of most ulcers.

11. Helicobacter pylori Infections  Spiral shaped stomach bacterium  Bacteria + acid secretion damages stomach, duodenal tissue  Causes inflammation (gastritis) & ulcers  H. Pylori can survive in acidic stomach because it produces urease enzyme  Urease generates substances that neutralize the stomach’s acid

12. Helicobacter pylori Infection H. pylori H. Pylori in stomach

13. 1. How H. pylori produces ulcers  Bacteria can penetrate stomach’s protective mucous lining because of shape & way they move  They produce substances the weaken stomach’s protective mucus & make the stomach cells more susceptible to the damage of acid & pepsin

14. 2. How H. pylori produces ulcers  Bacteria can also attach to stomach cells further weakening the stomach’s defensive mechanisms & producing local inflammation  H. pylori can also stimulate the stomach to produce more acid (not understood why)

15. 3. How H. pylori produces ulcers  Excess stomach acid & other irritating factors can cause inflammation of the duodenal bulb  In summary H. pylori induces gastritis through production of a variety of antigens, virulence factors, & soluble mediators  The bacterium deregulates, disarms & evades host immune responses to maintain chronic colonization of the gastric mucose

16. H. Pylori infection  Within weeks of infection with H. pylori, many develop gastritis (inflammation of stomach lining)  However, most will never experience severe symptoms or problem related to the infection  Unclear why some people do and others do not develop H. pylori related symptoms or ulcers

17. Lifestyle Factors Implicated in Ulcers  Cigarettes  Increase ulcer risk, slow rate of ulcer healing  Caffeine Foods  Can stimulate stomach acid secretion & aggravate ulcer pain  Alcohol Consumption  Ulcers more common in people with cirrhosis of liver  Emotional Stress  No longer thought to be cause of peptic ulcers, but emotional stress reported to increase ulcer pain

18. Nonsteroidal anti-inflammatory drugs (NSAIDs)  Prescription of NSAID’s (arthritis treatment)  Non-prescription NSAID- aspirin, ibuprofen & naproxen  Interfere with stomach’s ability to produce mucus & bicarbonate  Affect blood flow to the stomach & cell repair  Ulcers usually disappear once person stops taking drug

19. Diagnosis  Endoscopic Exams  X-ray examinations  Testing for H. pylori in blood, breath, & tissue samples

20. Treatment  With medicines  H-2 blockers  Acid pump inhibitors  Mucosal protective agents  In H. pylori, these meds used in combination with antibiotics  Lifestyle changes  MDs used to advise avoidance of spicy, fatty, or acidic foods  Surgery  Usually last result if people don’t respond to meds or develop complications