An ulcer in the duodenum, stomach, lower esophagus, or jejunum (after gastrojejunostomy) exposed to acid-peptic juices, with a defect/erosion extending through the muscularis mucosa into the submucosa or deeper.2 2. Etiology: 1.Definition: Peptic ulcerPeptic ulcerPeptic ulcer H. pylori spiral-shaped, gram-negative, urease-producing organism; lives under the mucus layer near gastric epithelial cells; transmitted faeco-oral or oral-oral (saliva) NSAIDs inhibit COX-1 → ↓ prostaglandins → ↓ mucosal barrier (↓mucus, ↓bicarbonate, ↓blood flow) → erosion/ulceration. COX-2 inhibitors spare the GI mucosa Smoking ↓ healing, ↑ recurrence Other factors reflux (esophageal ulcers), gastrinoma (Zollinger-Ellison), more common in men, familial tendency (especially DU), more common with blood group O 3- Symptoms: Epigastric pain: DU: worse when hungry & at night; relieved by food/antacids/vomiting GU: occurs 0.5–1 hr after meals; relieved by fasting/antacids/vomiting Nausea. Vomiting. GI bleeding. Appetite change. Heartburn. Episodic pain. 4- D.D: Pancreatitis Cholecystitis GERD / gastric cancer Inferior wall MI/ischemia 5. Complications: Hemorrhage → hematemesis, melena, anemia Fibrosis/obstruction Perforation (more common in DU) Penetration

Lifestyle avoid NSAIDs (or use COX-2 selective), stop smoking Medical Antacids H2 blockers (4–6 wks): Ranitidine,Famotidine Proton pump inhibitors: Omeprazole, Pantoprazole, Lansoprazole. H. pylori Eradication: First-line: 4 PPI + Clarithromycin + (Metronidazole or Tinidazole) + Amoxicillin. Quadruple therapy: 4 PPI bd + Bismuth (subsalicylate/subcitrate) + Metronidazole + Tetracycline. 7. Dental Care in Peptic Ulcer: Check platelet count before surgical procedures. Avoid aspirin-containing analgesics; selective analgesic use preferred. Minimize stress — shorter appointments Avoid steroids (worsen acid production). Avoid tetracycline/erythromycin in patients on aluminium/calcium/magnesium antacids. Sialogogues may be needed for anticholinergic-associated xerostomia. Bismuth subsalicylate (used for H. pylori) can harmlessly turn the tongue black. Long-term NSAID use for dental pain can itself cause ulcers — heals once stopped. 25 6. Treatment: