Gastric ULCERS, by definition, are a breach in the mucosa with extension into the submucosa or deeper layers. That is, the submucosa must be involved if a lesion is to be called an ulcer. In contrast, EROSIONS are mucosal defects that do NOT penetrate the muscularis mucosa.
The layers of the gut wall are as follows, beginning in the lumen:
1. Mucosa (epithelium, lamina propria, muscularis mucosa)
2. Submucosa (including Meissner's plexus)
3. Muscularis externa (including Auerbach's plexus)
Semble and Wu review the effects of nonsteroidal anti-inflammatory drugs (NSAIDs) on the gastric mucosa. Since NSAIDs inhibit both cyclooxygenase (COX) 1 and 2, with COX 1 being very important for gastric mucosal defense against gastric acid, NSAIDs decrease the gastric mucosa's ability to protect itself from the very acid that it produces. Therefore, it is necessary to be cautious when taking NSAIDs on a continual basis as their consumption may lead to gastric erosions, gastric ulcers, or upper gastrointestinal bleeding.
Ramakrishnan and Salinas review the symptoms, causes, and treatment of peptic/gastric ulcer disease which normally occurs in the stomach or proximal duodenum. The main causes for gastic ulcers are the usage of NSAIDs or infection with H. pylori. Gastric ulcers usually present with epigastric discomfort, loss of appetite, and weight loss due to the discomfort; the pain is usually relieved when antacids are taken or during food consumption. NSAIDs should be discontinued if an ulcer is detected and treatment should be given if H. pylori is found to be the causative agent. Treatment for H. pylori consists of eliminating the bacteria and administering a proton pump inhibitor for up to four weeks or until the ulcer heals.
Illustration A shows a gastric ulcer identified during an endoscopy.
Illustration B shows a diagram of the different layers of the stomach.
Answer 1, 2: These describe an erosion which does not penetrate into the submucosa.
Answer 3: To be classified as an ulcer the submucosa must also be penetrated.
Answer 5: While deeper tissue can be breached in ulceration, the serosa or adventitia is not required to be disrupted to differentiate an erosion from an ulceration.
Semble EL, Wu WC. NSAID-induced gastric mucosal damage. Am Fam Physician. 1987 Jun;35(6):101-8. Review.
PMID:3332745 (Link to Abstract)
Ramakrishnan K, Salinas RC. Peptic ulcer disease. Am Fam Physician. 2007 Oct 1;76(7):1005-12. Review.
PMID:17956071 (Link to Abstract)
USMLE World Step 1 QBank Question #290. Copyright © USMLEWorld, LLC 2012