Peptic Ulcer Disease: Pathophysiology Report

Peptic Ulcer Disease: Pathophysiology

A peptic ulcer can be defined as “a focal mucosal defect with inflammatory cell infiltration and coagulation necrosis extending through the muscularis mucosae” (Halter, 1995, p. 2). Contrary to erosion, a peptic ulcer extends beyond the epithelial structures into that intestinal tract section that happens to be in constant contact with pepsin and acid-containing gastric juice (Halter, 1995). Peptic ulcers cause an imbalance between the gastro duodenal defense-influencing factors such as prostaglandin, bicarbonate and mucus, and those such as NSAID use, H. pylori, pepsin and gastric acid, which promote mucosal damage (Elsevier, 2012). If peptic ulcers keep recurring at the same site, the imbalance worsens, resulting in peptic ulcer disease (PUD).

Don't use plagiarized sources. Get Your Custom Essay on
Peptic Ulcer Disease: Pathophysiology Report
Just from $9/Page
Order Essay

Two types of peptic ulcers can be deduced from the explanation above; duodenal and gastric ulcers (Elsevier, 2012).

Gastric Ulcers: there are four major classifications of gastric ulcers: type I, type II, type III and type IV (Elsevier, 2012). The class differences are solely based on the location of the ulcers within the gastrointestinal tract. Type I and type IV ulcers arise and develop in the gastric body and cardia respectively, and have the effect of reducing a patient’s basal output of acid (Elsevier, 2012). Type II and type III ulcers result in the hyper secretion of acid, and occur in the antrum and three centimeters from the pylorus respectively (Elsevier, 2012). The degree of acid secretion is, therefore, dependent upon an ulcer’s closeness to the pylorus (Elsevier, 2012).

Duodenal Ulcers: these usually accompany type III gastric ulcers but, unlike them, have not been found to bear any malignant potential (Elsevier, 2012). They come about when the innate mucosa defenses are overwhelmed by abnormal secretions of acid (Elsevier, 2012). Duodenal ulcers, like type II and type III ulcers, result in acid hyper-secretion. In this case, however, these hyper-secretions are usually within what can be considered the normal range (Elsevier, 2012). The pathogenesis of duodenal ulcers results in exaggerated levels of endogenous gastrin (Elsevier, 2012).


Between three and eight million people in the U.S. are affected by PUD, and 500,000 new cases (on average) are reported each year (Elsevier, 2012). Whereas there has been a significant decline in the incidence of DU in the recent past, that of GU has remained fairly stable, with only very slight increases (Halter, 1995). The trend portrayed by GU “is probably related to the large consumption of NSAIDs” and low-dose aspirin (Halter, 1995, p. 2, Elsevier, 2012). Therefore, in spite of the advancements in ulcer therapy such as PPIs and fiber optic endoscopy, PUD still continues to impose a significant burden on the U.S. economy (Elsevier, 2012).

Besides technological advancement, a number of other factors could have contributed to the decrease in the H. Pylori infection, as well as in the prevalence of DU. These include improved methods of food preparation, reduced family sizes, and improved sanitation (Elsevier, 2012). Men, and people of low socioeconomic status have, in this regard, been found to run higher risks of developing PUD (Elsevier, 2012). Older individuals too face an increased risk, because i) old age is associated with low levels of gastro duodenal defense-influencing factors (prostaglandin, bicarbonate and mucus), ii) conditions such as CVDs and arthritis, which are associated with old age, predispose the individual to the use of NSAIDs and aspirins, iii) elderly individuals “tend to have a higher rate of smoking and cumulative years of smoke exposure” (Elsevier, 2012).

PUD Risk Factors

H. Pylori Infection: More than three-quarters of all ulcers in the U.S. are associated with the H. Pylori bacterium (Elsevier, 2012). The microaerophilic rod-shaped bacterium attaches itself to the gastric epithelial cells, where it “lives within the gastric mucous layer” (Elsevier, 2012). The bacterium is transmitted from one person to another either through the fecal-oral or oral-oral routes (Elsevier, 2012). Experts hypothesize that H. Pylori disrupts the acid-regulating mechanism of the parietal cells, leading to acid-hyper-secretion (Halter, 1995). H. Pylori inhibits the duodenal mucosa’s capacity to buffer gastric acid’s caustic effects by inducing an inflammatory reaction that interferes with the epithelial cells’ ability to secrete bicarbonate (Elsevier, 2012).

NSAIDs: this is the second-most significant PUD risk factor (Elsevier, 2012). More than 60% of Americans aged above 65 use NSAIDs every week, and 34% everyday (Elsevier, 2012). Each year, approximately 15%-20% of new PUD cases are associated with arthritis patients. Even the very low dosages of aspirin have been found to increase the risk of PUD (Elsevier, 2012). NSAIDs are believed to suppress the production of prostaglandin (Elsevier, 2012). Two enzymes control the synthesis of prostaglandin; cyclooxygenase-2 and cyclooxygenase-1 (Elsevier, 2012). NSAIDs cause tissue inflammation, thereby inhibiting the activity of cyclooxygenase-1 (Elsevier, 2012). This reduced activity causes the homeostatic functions of gastrin to decrease. As a result, inadequate levels of bicarbonate and mucus are produced, increasing the epithelial cells’ vulnerability to damage by pepsin and hydrochloric acid (Elsevier, 2012).

Smoking, Alcohol, Stress and Cocaine: these have been found to increase the risk of PUD, though the mechanisms behind their operations are still unclear (Elsevier, 2012). Alcohol is hypothesized to increase the permeability of the mucosal cells, whereas smoking inhibits the production of prostaglandin and bicarbonate (Elsevier, 2012). However, “a direct cause-effect relationship has yet to be demonstrated” in these cases (Elsevier, 2012).

The At-Risk Population and Screening

Cocaine users, cigarette smokers, and alcohol drinkers run a higher risk of developing PUD (Elsevier, 2012). The elderly, individuals from families with PUD history, and patients who are frequently exposed to intensive care treatment settings run a high risk as well (Elsevier, 2012). One of two tests could be used in the diagnosis of an ulcer: upper endoscopy or upper GI (UMMC, 2013). In upper endoscopy, a thin tube fitted with a camera on one end is driven into the GI tract, through the mouth (UMMC, 2013). In the GI test, a patient is made to drink barium, after which they are exposed to several x-ray tests (UMMC, 2013). Both tests require H. Pylori screening. However, routine screening for the bacterium is not recommended (Elsevier, 2012). Moreover, “H. Pylori infection does not necessarily lead to PUD. Only 15% to 20% of infected individuals will develop PUD in their lifetime” (Elsevier, 2012).

PUD Prevention and Treatment


The treatment mechanism for an NSAID-induced ulcer differs from that caused by H. Pylori infection (UMMC, 2013). The treatment for a H. Pylori-induced ulcer is a combination of H. Pylori-killing antibiotics, PPIs, and bismuth (UMMC, 2013). An NSAID-induced ulcer is, on the other hand, treated using a PPI (UMMC, 2013). Many agents have been found to be equally effective for the treatment of PUD. This remains the case, despite the variations in the drugs’ modes of action (Halter, 1995). Due to this, investigators are beginning to shift their attention from aggressive mechanisms to more defensive ones (Halter, 1995).


PUD resulting from the use of NSAIDs can be prevented by limiting the use of the same (Elsevier, 2012). These medications should only be taken for brief, rather than routine courses, so as to prevent the acute inflammation of tissues; a situation that increases the gastro-intestinal tract’s vulnerability to damage by hydrochloric acid (Elsevier, 2012). Moreover, acetaminophen could be used as an alternative to NSAIDs and aspirin (UMMC, 2013). Medical advice should be sought if one has to use NSAIDs continuously over a long period. In such situations, the practitioner could either test for H. Pylori, prescribe an acid blocker or PPI to limit the NSAID effect, or offer misoprostol (UMMC, 2013).

Therapy aimed at controlling prophylactic acid levels could be administered to patients who run a high risk of developing GI tract complications due to NSAID use (Elsevier, 2012). This group includes persons who are aged above 60, have histories of prior GI tract complications (perforation, bleeding, PUD), suffer from serious chronic illnesses such as diabetes, hypertension and CVDs, or who use anticoagulants and (or) steroids concomitantly (Elsevier, 2002). The “concomitant administration of a PPI with NSAIDSs or aspirin has been shown to decrease the incidence of GI tract complications in these patients” (Elsevier, 2012).

Effective acid suppression has been found to significantly reduce the incidence of stress-related ulcers (Elsevier, 2012). PPIs (proton pump inhibitors) have been found to be more effective in controlling the production of acid, than H2RAs (Elsevier, 2012).

Lifestyle changing is one significant method of reducing one’s risk of developing PUD (Elsevier, 2012, UMMC, 2013). These changes could include smoking cessation, alcohol intake reduction, and cocaine avoidance (Elsevier, 2012, UMMC, 2013).


PUD is a serious concern, especially among the elderly. Significant progress has been made, over the years, in understanding its pathophysiology, but a single factor explaining its occurrence is yet to be discovered. What, however, comes out clearly is the fact that PUD, like many other complications, is not only treatable, but preventable. The prevention of PUD begins and ends with the individual. The lifestyle-changing decision has to come from the individual himself. If every individual takes it upon themselves to reduce their risks of developing PUD, then the incidence and prevalence of the same would significantly decline, and so would the economic costs that come with it.


Elsevier. (2012). Peptic Ulcer Disease. Clinical Key Elsevier. Retrieved from

Halter, F. (1995). Pathophysiology of Peptic Ulcer Disease. In D. Hollander & G. Tytgat (Eds.), Sucralfate: from Basic Science to the Bedside (Ch. 10). New York: Plenum Press.

UMMC. (2013). Peptic Ulcer. The University of Maryland Medical Center. Retrieved from

Get Professional Assignment Help Cheaply

Buy Custom Essay

Are you busy and do not have time to handle your assignment? Are you scared that your paper will not make the grade? Do you have responsibilities that may hinder you from turning in your assignment on time? Are you tired and can barely handle your assignment? Are your grades inconsistent?

Whichever your reason is, it is valid! You can get professional academic help from our service at affordable rates. We have a team of professional academic writers who can handle all your assignments.

Why Choose Our Academic Writing Service?

  • Plagiarism free papers
  • Timely delivery
  • Any deadline
  • Skilled, Experienced Native English Writers
  • Subject-relevant academic writer
  • Adherence to paper instructions
  • Ability to tackle bulk assignments
  • Reasonable prices
  • 24/7 Customer Support
  • Get superb grades consistently

Online Academic Help With Different Subjects


Students barely have time to read. We got you! Have your literature essay or book review written without having the hassle of reading the book. You can get your literature paper custom-written for you by our literature specialists.


Do you struggle with finance? No need to torture yourself if finance is not your cup of tea. You can order your finance paper from our academic writing service and get 100% original work from competent finance experts.

Computer science

Computer science is a tough subject. Fortunately, our computer science experts are up to the match. No need to stress and have sleepless nights. Our academic writers will tackle all your computer science assignments and deliver them on time. Let us handle all your python, java, ruby, JavaScript, php , C+ assignments!


While psychology may be an interesting subject, you may lack sufficient time to handle your assignments. Don’t despair; by using our academic writing service, you can be assured of perfect grades. Moreover, your grades will be consistent.


Engineering is quite a demanding subject. Students face a lot of pressure and barely have enough time to do what they love to do. Our academic writing service got you covered! Our engineering specialists follow the paper instructions and ensure timely delivery of the paper.


In the nursing course, you may have difficulties with literature reviews, annotated bibliographies, critical essays, and other assignments. Our nursing assignment writers will offer you professional nursing paper help at low prices.


Truth be told, sociology papers can be quite exhausting. Our academic writing service relieves you of fatigue, pressure, and stress. You can relax and have peace of mind as our academic writers handle your sociology assignment.


We take pride in having some of the best business writers in the industry. Our business writers have a lot of experience in the field. They are reliable, and you can be assured of a high-grade paper. They are able to handle business papers of any subject, length, deadline, and difficulty!


We boast of having some of the most experienced statistics experts in the industry. Our statistics experts have diverse skills, expertise, and knowledge to handle any kind of assignment. They have access to all kinds of software to get your assignment done.


Writing a law essay may prove to be an insurmountable obstacle, especially when you need to know the peculiarities of the legislative framework. Take advantage of our top-notch law specialists and get superb grades and 100% satisfaction.

What discipline/subjects do you deal in?

We have highlighted some of the most popular subjects we handle above. Those are just a tip of the iceberg. We deal in all academic disciplines since our writers are as diverse. They have been drawn from across all disciplines, and orders are assigned to those writers believed to be the best in the field. In a nutshell, there is no task we cannot handle; all you need to do is place your order with us. As long as your instructions are clear, just trust we shall deliver irrespective of the discipline.

Are your writers competent enough to handle my paper?

Our essay writers are graduates with bachelor's, masters, Ph.D., and doctorate degrees in various subjects. The minimum requirement to be an essay writer with our essay writing service is to have a college degree. All our academic writers have a minimum of two years of academic writing. We have a stringent recruitment process to ensure that we get only the most competent essay writers in the industry. We also ensure that the writers are handsomely compensated for their value. The majority of our writers are native English speakers. As such, the fluency of language and grammar is impeccable.

What if I don’t like the paper?

There is a very low likelihood that you won’t like the paper.

Reasons being:

  • When assigning your order, we match the paper’s discipline with the writer’s field/specialization. Since all our writers are graduates, we match the paper’s subject with the field the writer studied. For instance, if it’s a nursing paper, only a nursing graduate and writer will handle it. Furthermore, all our writers have academic writing experience and top-notch research skills.
  • We have a quality assurance that reviews the paper before it gets to you. As such, we ensure that you get a paper that meets the required standard and will most definitely make the grade.

In the event that you don’t like your paper:

  • The writer will revise the paper up to your pleasing. You have unlimited revisions. You simply need to highlight what specifically you don’t like about the paper, and the writer will make the amendments. The paper will be revised until you are satisfied. Revisions are free of charge
  • We will have a different writer write the paper from scratch.
  • Last resort, if the above does not work, we will refund your money.

Will the professor find out I didn’t write the paper myself?

Not at all. All papers are written from scratch. There is no way your tutor or instructor will realize that you did not write the paper yourself. In fact, we recommend using our assignment help services for consistent results.

What if the paper is plagiarized?

We check all papers for plagiarism before we submit them. We use powerful plagiarism checking software such as SafeAssign, LopesWrite, and Turnitin. We also upload the plagiarism report so that you can review it. We understand that plagiarism is academic suicide. We would not take the risk of submitting plagiarized work and jeopardize your academic journey. Furthermore, we do not sell or use prewritten papers, and each paper is written from scratch.

When will I get my paper?

You determine when you get the paper by setting the deadline when placing the order. All papers are delivered within the deadline. We are well aware that we operate in a time-sensitive industry. As such, we have laid out strategies to ensure that the client receives the paper on time and they never miss the deadline. We understand that papers that are submitted late have some points deducted. We do not want you to miss any points due to late submission. We work on beating deadlines by huge margins in order to ensure that you have ample time to review the paper before you submit it.

Will anyone find out that I used your services?

We have a privacy and confidentiality policy that guides our work. We NEVER share any customer information with third parties. Noone will ever know that you used our assignment help services. It’s only between you and us. We are bound by our policies to protect the customer’s identity and information. All your information, such as your names, phone number, email, order information, and so on, are protected. We have robust security systems that ensure that your data is protected. Hacking our systems is close to impossible, and it has never happened.

How our Assignment Help Service Works

1. Place an order

You fill all the paper instructions in the order form. Make sure you include all the helpful materials so that our academic writers can deliver the perfect paper. It will also help to eliminate unnecessary revisions.

2. Pay for the order

Proceed to pay for the paper so that it can be assigned to one of our expert academic writers. The paper subject is matched with the writer’s area of specialization.

3. Track the progress

You communicate with the writer and know about the progress of the paper. The client can ask the writer for drafts of the paper. The client can upload extra material and include additional instructions from the lecturer. Receive a paper.

4. Download the paper

The paper is sent to your email and uploaded to your personal account. You also get a plagiarism report attached to your paper.

smile and order essay GET A PERFECT SCORE!!! smile and order essay Buy Custom Essay

Place your order
(550 words)

Approximate price: $22

Calculate the price of your order

550 words
We'll send you the first draft for approval by September 11, 2018 at 10:52 AM
Total price:
The price is based on these factors:
Academic level
Number of pages
Basic features
  • Free title page and bibliography
  • Unlimited revisions
  • Plagiarism-free guarantee
  • Money-back guarantee
  • 24/7 support
On-demand options
  • Writer’s samples
  • Part-by-part delivery
  • Overnight delivery
  • Copies of used sources
  • Expert Proofreading
Paper format
  • 275 words per page
  • 12 pt Arial/Times New Roman
  • Double line spacing
  • Any citation style (APA, MLA, Chicago/Turabian, Harvard)

Our guarantees

Delivering a high-quality product at a reasonable price is not enough anymore.
That’s why we have developed 5 beneficial guarantees that will make your experience with our service enjoyable, easy, and safe.

Money-back guarantee

You have to be 100% sure of the quality of your product to give a money-back guarantee. This describes us perfectly. Make sure that this guarantee is totally transparent.

Read more

Zero-plagiarism guarantee

Each paper is composed from scratch, according to your instructions. It is then checked by our plagiarism-detection software. There is no gap where plagiarism could squeeze in.

Read more

Free-revision policy

Thanks to our free revisions, there is no way for you to be unsatisfied. We will work on your paper until you are completely happy with the result.

Read more

Privacy policy

Your email is safe, as we store it according to international data protection rules. Your bank details are secure, as we use only reliable payment systems.

Read more

Fair-cooperation guarantee

By sending us your money, you buy the service we provide. Check out our terms and conditions if you prefer business talks to be laid out in official language.

Read more
error: Content is protected !!
Open chat
Need assignment help? You can contact our live agent via WhatsApp using +1 718 717 2861

Feel free to ask questions, clarifications, or discounts available when placing an order.
  +1 718 717 2861           + 44 161 818 7126           [email protected]
  +1 718 717 2861         [email protected]