Peptic ulcer

DR. ARUN KUMAR
ASSOCIATE PROFESSOR
SANSKAR COLLEGE OF PHARMACY & RESEARCH, HAPUR (UP) INDIA

1. Peptic Ulcer

2. Peptic ulcer disease  ( PUD ) is a break in the lining of the stomach, first part of the small intestine or occasionally the lower esophagus.  An ulcer in the stomach is known as a  gastric ulcer  while that in the first part of the intestines is known as duodenal ulcer .  The most common symptoms of a duodenal ulcer are waking at night with upper abdominal pain or upper abdominal pain that improves with eating.  With a gastric ulcer the pain may worsen with eating. The pain is often described as a burning.

3. Symptoms   Abdominal Pain.  The pain is often described as burning . Vomiting, weight loss, or poor appetite Complications may include bleeding, perforation and blockage of the stomach . Waterbrash  (rush of saliva after an episode of regurgitation to dilute the acid in esophagus. Nausea and copious vomiting A history of heartburn, gastroesophageal reflux disease (GERD) and use of certain forms of medication can raise the suspicion for peptic ulcer.

4. Complications: Gastrointestinal bleeding is the most common complication. Sudden large bleeding can be life-threatening.  It occurs when the ulcer erodes one of the blood vessels, such as the gastroduodenal artery. Perforation (a hole in the wall of the gastrointestinal tract ). Erosion of the gastro-intestinal wall by the ulcer leads to spillage of the stomach or intestinal content into the abdominal cavity. Penetration is a form of perforation in which the hole leads to and the ulcer continues into adjacent organs such as the liver and pancreas.

5. Causes H. pylori NSAIDs Stress Diet Gastric ischmeia

6. Pathogenesis of peptic disease There is a strong association between  H. pylori  infection and gastroduodenal ulcers.  H. pylori  causes an inflammatory response in gastric mucosa, with induction of epithelium derived cytokines, predominantly interleukin (IL) 8 and IL 1 β. Influx of neutrophils and macrophages into the gastric mucosa with release of lysosomal enzymes, leukotrienes (LT ), hampers mucosal defense and stimulates the process of ulcer formation.

7. Diagnosis Abdominal Pain Ultrasound EGD (Endoscopy and Gastroscopy ) Rapid urease test Stool antigen test

8. Treatment Proton pump inhibitors  ( PPIs ) work by reducing the amount of acid your stomach produces, preventing further damage to the ulcer as it heals naturally. They're usually  prescribed  for 4 to 8 weeks.  Omeprazole ,  pantoprazole  and lansoprazole  are the  PPIs  most commonly used to treat stomach ulcers . Histamine (H2) receptor antagonists such as Ranitidine, Famotidine , Cimatidine for duodenal ulcers.

9. PREVENTION You may find relief from the pain of a stomach ulcer if you: Choose a healthy diet. Consider foods containing probiotics. Consider switching pain relievers. Control stress. Don't smoke. Limit or avoid alcohol. Try to get enough sleep.