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Peptic Ulcer

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Peptic Ulcer and Its Pathophysiology

Our body develops sores due to various reasons. When it happens in the interior lining of the stomach, small intestine, and lower esophagus, it is called a peptic ulcer. In this section, we will study how peptic ulcers form and how they can be prevented from recurring. We will also discuss the treatment plans and how one can reduce the risk of developing such ulcers in the digestive system. Let us study the pathology of peptic ulcer disease and then proceed to its symptoms and treatment.

What is Peptic Ulcer Disease?

The formation of open sores in the interior lining of the stomach, small intestine, and the lower esophagus or the food pipe is called a peptic ulcer. The inner lining of these organs breaks causing perforations. This perforation exposes the vulnerable interior tissues of the organs to the digestive enzymes. It also happens due to the infection caused by the excessive growth of Helicobacter pylori bacterium.

As per the pathology of peptic ulcer disease, it is of three types considering the location.

  • Gastric Ulcers

This ulcer forms in the inner lining of the stomach. The pathophysiology of gastric ulcer suggests that the inner lining of tissues that protects the organ from a highly acidic environment forms a perforation. This perforation can happen due to the H. pylori infection or for various other reasons. The breaking of this tissue exposes the internal tissues to the acidic environment causing more harm.

  • Esophageal Ulcers

As per the name, the ulcerative formations take place at the lower level of the food pipe. These sores open the inner lining of the food pipe increasing vulnerability to infections and the development of other grave diseases.

  • Duodenal Ulcers

The first portion of the small intestine that emerges from the pyloric end of the stomach is called the duodenum. The formation of perforations in this section of the small intestine is called a duodenal ulcer.

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Pathology of Peptic Ulcer Disease

The discontinuation of the gastric epithelium, the prime defensive mucosal layer that protects the inner tissues, causes perforations. These perforations also happen due to erosion of this layer from the increased population of Helicobacter pylori signifying the occurrence of an infection. The increased growth of this bacterium that generally resides inside the GI tract can cause ulcers. In fact, research suggests that the consumption of non-steroidal anti-inflammatory drugs (NSAIDs) for a prolonged period can also cause the formation of peptic ulcers.

Whenever a patient suffers from recurrent stomach pain within 15-30 minutes of consuming food, he is recommended to take an H. pylori test to check the increase in the population of this bacterium. In chronic cases, an endoscopy is done to detect the condition and location of the ulcers in the GI tract. If you follow the peptic ulcer pathophysiology flow chart below, you will understand how this disease develops.

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Symptoms of Peptic Ulcers

The common symptoms of peptic ulcers are:

  • Burning sensation in the stomach

  • Recurring pain after eating a meal

  • Heartburn

  • Intolerance to oily and fatty food

  • Nausea

  • Chest pain

  • Vomiting

  • Dark stools due to the presence of blood

  • A drastic change in appetite

  • Unexplained loss of weight

These symptoms generally indicate something wrong with the GI tract and its digestion process. The pain in a particular area can signify the presence of ulcers in those regions. The pain can range from mild to severe. It can happen mostly at night when the patient lies down. The pain can also sometimes radiate from chest to navel. Small ulcers might not show any symptoms at an early stage. The symptoms surface when these ulcers grow in size.

As per the chronic gastric ulcer histology, the ulcerative regions are filled with inflamed debris of tissues. These regions are also infiltrated by white blood cells due to the H. pylori infection and inflammation.

Treatment of Peptic Ulcer

The treatment of the ulcers in the GI tract is designed based on their chronicity and stage. If the pathology of peptic ulcer disease suggests bacterial infection then the specialist doctors will prescribe a combination of antibiotics and proton pump inhibitors (PPIs). PPIs are medicines that reduce the formation of acid in the stomach so that the erosion can be stopped and treatment can be utilized effectively.

The antibiotic will stop the growth of H. pylori and will heal the inflammation. If it has reached an advanced stage, it might need invasive procedures. Many refractory ulcers do not heal with such treatment plans. Sometimes, patients smoke and drink alcohol making the treatment ineffective.


Peptic ulcers either form due to the H. pylori infection or due to prolonged use of NSAIDs. The peptic ulcer pathophysiology flow chart shows how this disease develops step by step. The symptoms might vary depending on the chronicity of the disease. Study the pathophysiology of this disease to understand what it can cause and how it can be prevented.

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FAQs on Peptic Ulcer

1.  What Happens When the Protective Mucosal Layer of the Stomach is Eroded?

Ans: Due to the discontinuation of the protective mucosal layer in the gastric region, the gastric acid and enzymes come in contact with the inner tissues causing more erosion and perforation. This causes the formation of peptic ulcers. It can happen in the lower esophagus, stomach, and duodenum.

2.  How Can We Prevent Peptic Ulcers?

Ans: We need to sleep and eat square meals while maintaining proper timing. Skipping meals causes more harm. Moreover, unresolved stress can also cause excess secretion of gastric acids causing the erosion of the mucosal layer. Restrict the use of NSAIDs and stop smoking/drinking. This reduces the probability of developing ulcers in the GI tracts.

3.  Why are Proton Pump Inhibitors Prescribed?

Ans: Proton pump inhibitors (PPIs) are prescribed to reduce the formation and secretion of gastric acids. This medication is given to stop the erosion of the weak mucosal regions and to heal the ulcerative regions faster. If the prime reason for the formation of peptic ulcer is gastric acid then PPIs are prescribed by specialist doctors.