PEPTIC ULCER DISEASE AND ITS MANAGEMENT.pptx

Presentation on PUD and it's management.

1. PEPTIC ULCER DISEASE Michael Adjei, PharmD.

2. content Introduction Epidemiology Pathophysiology Signs & Symptoms Investigations Treatment Case Study

3. intr0ducti0n Peptic ulcer disease (PUD) refers to a defect in the gastric or duodenal mucosal wall that extends through the muscularis mucosa into the deeper layers of the submucosa.

4. INTRODUCTION Three common forms exist; H. pylori associated PUD NSAID induced PUD Stress-related mucosal damage (SRMD) Other forms include Zollinger-Ellison Syndrome, Vascular insufficiency(Crack-cocaine associated), Chemotherapy and Radiotherapy induced PUD, etc … Complications of PUD include gastrointestinal (GI) bleeding , perforation , and obstruction

5. epidemiology The global prevalence of PUD is approximately 8.09%, as of 2019 ( Xie X. et al, 2022) PUD affects approximately 10% of women and 12% of men in the United States, resulting in 4 million cases annually. The prevalence of H. pylori infection in the United States and Canada is about 30%, whereas the global prevalence is greater than 50%. Risk factors include Alcohol ingestion Cigarette smoking Diet Psychological stress Steroids

6. PATHOPHYSIOLOGY Peptic ulcers occur when the balance between aggressive factors and mucosal defensive mechanisms are disrupted. Aggressive factors: gastric acid , pepsin , bile salts , H . pylori , and NSAIDs Defensive factors: mucosal blood flow , mucus , mucosal bicarbonate secretion , mucosal cell restitution , and epithelial cell renewal.

7. PATHOPHYSIOLOGY H. Pylori-related ulcers H. pylori is a gram-negative, spiral-shaped bacillus that thrives in a microaerophilic environment. The organism survives in the acidic milieu of the stomach by producing urease, an enzyme that hydrolyzes the urea in gastric juice into carbon dioxide and ammonia.

8. SIGNS There may be no abdominal signs Weight loss (sometimes in gastric ulcer) Weight gain (sometimes in duodenal ulcer) Tenderness - epigastrium, right hypochondrium or umbilical region Iron deficiency anaemia Overt GI bleeding

9. SYMPTOMS Episodic abdominal pain (often aggravated by dietary indiscretions and lifestyle) May be a minor discomfort, gnawing, burning, dull ache or very severe pain Typically pain is in the epigastrium or right hypochondrium Occasionally high up behind the sternum or low down around the umbilicus In duodenal ulcer, pain typically comes on when the patient is hungry and may wake the patient up in the middle of the night. In gastric ulcer, it is typically worsened by food, and may be relieved by vomiting Vomiting

10. INVESTIGATIONS Haemoglobin H. pylori (stool antigen, urea breath test and serology) Oesophago -gastro-duodenoscopy (endoscopy) Barium meal (in the absence of endoscopy) Stool examination (to exclude intestinal parasites)

11. TREATMENT The treatment selected for PUD depends on the etiology of the ulcer, whether the ulcer is new or recurrent, and whether complications have occurred. The goals of PUD therapy are to resolve symptoms, reduce acid secretion, promote epithelial healing, prevent and/or manage ulcer related complications, and prevent ulcer recurrence.

12. TREATMENT Non-pharmacological treatment Avoid alcohol and tobacco intake Avoid foods that aggravate the pain Allay anxiety and stress Surgical treatment: for chronic cases with severe periodic attacks, failed medical treatment and complications e.g. perforation, gastric outlet obstruction and haemorrhage )

13. CASE STUDY

14. Patient’s info Patient’s initials: R. O. Age: 31 Sex: Male Weight: 65kg Appointment date: 19/12/2023

15. Presenting complaints Chest pain x 1 month ago Back pain x 1 month ago Streaks of blood after urinating x 1 month ago Whitish discharge from the penis x 1 month ago

16. History of presenting complaints Patient who is not known of any chronic illness presented to the facility with the above s/s of 1 month duration . chest pain has a sudden onset and describes chest pain to have a burning sensation, which radiates to the back and worsen by heavy lifting of objects . severity of pain is 6/10. client said he has been experiencing streaks of blood after every micturition, and associated with pain in the penis. and also said after every micturition he sees whitish discharge ( discharge comes after every 10mins ). client took amoxicillin for 2 days and he is on herbal medications of which he is unable to identify .s/s still persisted and reported to the facility for mgt .

17. odq ; headache + , palpitations - , easy fatigue -, dizziness-, nausea+ ,vomit-, polyuria-, frequency +, urgency -, dysuria+, incomplete void +, pain upon eating + (sometimes) pmh ; has no past medical hx dh ; amoxicillin and herbal meds fmh ; hpt -, dm-, asthma -, scd sh ; stays at Akweteyman , glass cutter, nhis -, alcohol+ (club 1 bottle ) , smoking-

18. o/e a middle aged who looks stable , afebrile , not pale ,anicteric , not in resp distress, hydration is good cvs ; heart sounds l + ll present , no murmur heard resp a/e is adequate bilaterally , b/s - vesicular no added sounds abd : full, soft , mwr + ,epigastric tenderness, cns ; grossly intact

19. Investigations Urine R/E LEUCOCUYE= ++ EPITH=4/HPF PUS=30/HPF H. pylori Test - POSITIVE

20. Diagnosis UTI, site not specified H. pylori infection

21. Plan To give Tab Clarithromycin 500mg BD x 14 days To give Cap Amoxicillin 1g BD x 14 days To give Cap Omeprazole 20mg BD x 14 days To give Tab Ciprofloxacin 500mg BD x 7 days

22. Pharmaceutical care issues Inappropriate choice of antibiotic therapry

23. intervention Switch Ciprofloxacin to Levofloxacin Withhold Clarithromycin

24. Outcome Intervention was accepted. Client was sent home and scheduled for a review in two weeks