Peptic Ulcer Disease by Dr James SU.pptx

An introductory and brief presentation of peptic ulcer disease.
offering a baseline and slightly in-depth information on the course.

1. Peptic Ulcer Disease Dr. James S. U. Charis -Med Hospital

2. Dypepsia Persistent or recurrent pain or discomfort centered in the upper abdomen. Not all patients with dyspepsia have peptic ulcer. The most common causes of dyspepsia are -non-ulcer or functional dyspepsia, -GORD and -peptic ulcer

3. Peptic Ulcer Disease Peptic ulcer accounts for 10–15% of dyspepsia. Peptic ulcer is a disruption in the mucosal layer of the stomach or duodenum that extends through the muscularis mucosa.

4. Risk/Etiologic Factors Helicobacter pylori infection Chronic NSAIDs and Corticosteroids use Tobacco use Alcohol consumption Zollinger -Ellison Syndrome (Acid hypersecretory state) Physiologic stress: burns, CNS trauma Genetics: blood group O, family history Others: COPD, CKD, Cirrhosis, bile reflux

5. Pathophysiology PUD occurs when there is an imbalance between the aggressive and protective factors interacting in the gastrointestinal wall. Aggressive factors: acid, pepsin, bile salts, tobacco, H. pylori (urease, adhesins , flagella), NSAIDS Protective factors: mucus, bicarbonate, mucosal blood flow, prostaglandins

6. pathophysiology associated with H. pylori infection production of cytotoxin -associated gene A ( CagA ) proteins and vacuolating cytotoxins which activate the inflammatory cascade… enzymes produced by H. pylori may cause tissue damage include: UREASE , haemolysins , neuraminidase and fucosidase . gastrin homeostasis is also altered resulting in Long-standing hypergastrinaemia leads to an increased parietal cell mass … All these cause inflammation and ulcer formation.

7. Clinical features History (Pain) Gastric Ulcer Duodenal ulcer Location Epigastrum Epigastrum Character Burning or gnawing Burning or gnawing Aggravating factor Food Hunger Relieving factor Antacid Antacid or food Bleeding Haematemesis commonly Melelaena more common Assoc. symptoms Nausea, weight loss Hyperphagia , weight gain

8. Alarm Features Features that warrant prompt gastroenterologist review Bleeding or anaemia Early satiety Unexplained weight loss Progressive dysphagia Recurrent vomiting Gastrointestinal cancer

9. Investigations Blood/Stool for H. pylori Upper GI endoscopy Double-contrast barium meal Urea breath test ZES: serum gastrin, gastric acid analysis

10. Treatment Drug treatment used in PUD Acid suppressing drugs - PPI: Omeprazole, lansoprazole , rabeprazole - H2 receptor antagonists: Cimetidine, ranitidine, nizatidine - Antacids: gascol , gaviscon 2. Mucosal protective agents: sucralfate , bismuth subsalicylate, misoprostol 3. Antibiotics: amoxicillin, tetracycline, clarithromycin, metronidazole

11. Treatment regimen for H. pylori eradication Triple therapy regimen eg Omeprazole + clarithromycin + metronidazole (or amoxicillin) ranitidine + tetracycline + clarithromycin (or metronidazole) Quadruple therapy Omeprazole + bismuth subsalicylate + metronidazole + tetracycline

12. Surgery Vagotomy and drainage ( pyloroplasty ) Vagotomy with antrectomy Subtotal gastrectomy

13. Complications Gastrointestinal bleeding Perforation Gastric outlet obstruction Weight loss Gastric cancer