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phuluong2k
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08/21/04 - 02:19 AM       #1

In gastric ulcer, the pain is aggravated by food, Is it due to the contact between the food and the ulcer ?

thank for help

phuluong2k
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08/21/04 - 02:25 AM       #2

Why in duodenal ulcer, food relieved pain, but in gastric ulcer it increase the pain

SMALLFIDGET
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08/21/04 - 03:42 AM       #3

Phuluong2k,

Nice Q.

Pain in Peptic Ulcer Disease is actually "acid-induced". It is due to acid stimulation of chemical receptors and/ or alterations of gastric motility.

See, food intake causes transient partial neutralisation of gastric acid> hence pain is relieved.

Another aspect is why the pt. wakes up at night with pain?
Because, there is no food in stomach to buffer basal acid secretion and also due to cyclical variation in basal acid secretion, which is greatest from midnight to 4 am.

Coming to pain in gastric ulcers...it is again due to acid and not food and furthermore gastric emptying is delayed in GU.

This is physiology stuff...

Hope that helped smiling face

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phuluong2k
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08/21/04 - 02:47 PM       #4

Yeah I agree with you about the physiology of acid induced pain
so normally the pain is relieved by food

But there is another aspect that in Gastric ulcers, there is an increase of pain after eating, so what is the mechanism ?

Is it due to the gastroduodenal motility after eating

thanks

Malaysian
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08/22/04 - 06:32 AM       #5

In peptic ulcer disease there are 2 type of ulcers---gastric and duodenal ulcers.

If pain is relieved in taking food it hints towards a duodenal ulcer whereas on taking food its aggravated then it hints towaRDS gastric ulcer.

This is because when food is ingested,it causes stimulation of stomach to produce acid therefore worsening the gastric ulcer and therefore pain.
In duodenal ulcer the pain is relieved because when food is ingested it means the pylorus to close and so no more seeping of gastric acid into the duodenum.The food also helps buffer the gastric acid when it enters the duodenum....and also stimulates the alkaline pancreatic secretions helping to buffer the Ph in the duodenum.No food....no stimulation for pancreatic secretion......acid from stomach from basal stomach acid secretion causing worsening pain of duodenal ulcer.


Therefore due to the above...patients with gastric ulcers tend to avoid eating....or induce vomiting upon ingestion of food as the food aggravates their pain.They tend to have history of loss of weight.

In patients with duodenal ulcers the food relieves pain and so these patients tend to eat more regularly....having to wake up at night to eat to relieve the pain.They have a tendency of putting on weight.

What I described above is from what my professors taught me from clinical classes and not really from a book....but i hope it helped.

To the best of my knowledge the pain due to peptic ulcer disease has nothing to do with gastric/intestinal motility or direct contact/effect of food(unless the food happens to be spicy and are able to change the Ph of the intestines.)

phuluong2k
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08/22/04 - 06:36 AM       #6

yeah, good explain

thank

SMALLFIDGET
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08/22/04 - 09:00 AM       #7

Very well explained, Malaysian! However, I differ at one point.

"Malaysian" wrote:
"To the best of my knowledge the pain due to peptic ulcer disease has nothing to do with gastric/intestinal motility"


For the above statement, please refer to the chapter of PUD in Harrison's internal medicine...it is clearly mentioned.

Thanks and bye.

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