Digestive diseases

1. Digestive diseases

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

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

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 20th century, peptic ulcers were rare1 • 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 year2 • A total of 1,453,892 first-listed PUD hospitalizations were estimated for 1998–2005 1. MajumdarD, 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