Refers to an ulcer found in lower oesophagus, stomach and duodenum

Aetiology

• H. pylori
  • 90% of duodenal ulcers
  • 60% of gastric ulcers
• NSAIDs - most of the rest of cases
• Zollinger Ellison syndrome - gastrinoma (tumour in the head of pancreas or duodenum) produces large amounts of gastrin which increases stomach acid → peptic ulcer disease
• Occur in predominantly middle-aged men but anyone is susceptible

Pathophysiology

H. pylori

• Gram negative microaerophilic flagellated bacillus which is acquired in infancy (oral-oral/faecal oral spread), although consequences don’t arise until later life
• pylori inhabits a niche between the epithelial cell surface and the mucous barrier and excites an acute inflammatory response
• If cleared - no pathology (majority of people)
• In 20-40% of people, H. pylori is not cleared and there is chronic active inflammation, resulting in a breach in the GI mucosa - ulcer

NSAIDs

• Small abrasions to the lining of the stomach happen all the time, would normally heal
• NSAIDs inhibit prostaglandin formation which reduces the ability of the stomach to heal itself

Gastric ulcers

• Typically manifests along the greater curvature and gastric antrum
• Associated with gastric carcinoma

Duodenal ulcer

• Typically first part of duodenum