DIGESTIVE DISEASES Main Characteristics The digestive system is

  • Slides: 20
Download presentation
DIGESTIVE DISEASES

DIGESTIVE DISEASES

Main Characteristics The digestive system is composed of:

Main Characteristics The digestive system is composed of:

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

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

Peptic Ulcers Ulcer- sore or lesion that forms in the lining of the stomach

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

Peptic Ulcers in the stomach � Gastric or stomach ulcers Ulcers in duodenum �

Peptic Ulcers in the stomach � Gastric or stomach ulcers Ulcers in duodenum � Duodenal ulcers

Common Ulcer Symptoms Most common: gnawing or burning pain in the abdomen between the

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

Other Ulcer Symptoms Emergency symptoms: � Bleeding If in stomach & duodenum bleeding is

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

Peptic Ulcer Epidemiology Before 20 th century, peptic ulcers were rare 1 About 20

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. DOIPub. Med

Peptic Ulcer Epidemiology Hospitalization rates were higher for adults ≥ 65 years of age

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

Peptic Ulcer Theories For almost a century: believed that ulcers were caused by lifestyle

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.

Helicobacter pylori Infections Spiral shaped stomach bacterium Bacteria + acid secretion damages stomach, duodenal

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

Helicobacter pylori Infection H. pylori H. Pylori in stomach

Helicobacter pylori Infection H. pylori H. Pylori in stomach

1. How H. pylori produces ulcers Bacteria can penetrate stomach’s protective mucous lining because

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

2. How H. pylori produces ulcers Bacteria can also attach to stomach cells further

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)

3. How H. pylori produces ulcers Excess stomach acid & other irritating factors can

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

H. Pylori infection Within weeks of infection with H. pylori, many develop gastritis (inflammation

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

Lifestyle Factors Implicated in Ulcers Cigarettes � Increase ulcer risk, slow rate of ulcer

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

Nonsteroidal anti-inflammatory drugs (NSAIDs) Prescription of NSAID’s (arthritis treatment) Non-prescription NSAID- aspirin, ibuprofen &

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

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

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

Treatment With medicines � H-2 blockers � Acid pump inhibitors � Mucosal protective agents

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