Peptic ulcer disease ppt.pptx

Peptic ulcer disease ppt for study purpose.

1. Peptic Ulcer Disease Dr Md Shamshir Alam, PhD

2. Introduction Peptic ulcer disease (PUD) refers to ulceration of the mucosa anywhere in the GI tract due to exposure to acid and pepsin. Erosion of GI mucosa resulting from digestive action of HCl and pepsin. Lesion may subsequently occur into the lamina propria and submucosa to cause bleeding. Most of peptic ulcer occur either in the duodenum, or in the stomach. Ulcer may also occur in the lower esophagus due to reflexing of gastric content. They can range in size from a few millimeters to a few centimeters The 2 most common forms/locations of PUD are Duodenal ulcer Gastric ulcer

3. Duodenal Ulcers It is the m ost common form of PUD. 3 times more common than gastric ulcer. U sually located in duodenal bulb of the small intestine. Most commonly occurs in people between the age of 30 and 50 years.

4. Gastric Ulcers Less common than duodenal ulcer. Especially in the absence of chronic use of NSAIDS Most commonly located in the lesser curvature of the antrum of the stomach. More common in people greater than 60 years.

5. Risk f actors for PUD Lifestyle – Smoking, Acidic drinks, Medications ( eg . NSAIDS, Steroid therapy). H. Pylori infection – 90% have this bacterium – Passed from person to person (fecal-oral route or oral-oral route). Age – Duodenal 30-40 – Gastric over 50years. Gender – Duodenal: are increasing in older women. Genetic factors – More likely if family member has Hx of PUD. Other factors: stress, can worsen (but not the cause).

6. Causes/etiologies of PUD Common causes of PUD Helicobacter pylori ( H.pylori ) infection Nonsteroidal Anti-inflammatory Drugs (NSAIDs) Critical illness (stress-related mucosal damage) Uncommon causes of PUD Idiopathic (non-H.pylori, non- NSAID) Hypersecretion of gastric acid (e.g. Zollinger Ellison syndrome) Viral infections Radiation therapy Chemotherapy

7. Zollinger -Ellison Syndrome (ZES) ZES is characterized by gastric acid hypersecretion and recurrent peptic ulcers that result from a gastrin-producing tumor More than 50% of gastrinomas are malignant ZES is suspected for patients with multiple ulcers and recurrent or refractory PUD often accompanied by esophagitis or ulcer complications Only accounts for 0.1% to 1% of those with duodenal ulcer

8. Pathophysiology Under normal conditions, a physiologic balance exists between gastric acid secretion and gastroduodenal mucosal defense. Gastric and duodenal ulcers develop because of an imbalance between aggressive factors and mechanisms that maintain mucosal integrity. There is an increase in mucosal injury and a decrease in mucosal defense. Aggressive factors (H. pylori, NSAIDs) cause mucosal injury and a decrease in mucosal defenses and healing (decreased mucous, decreased bicarbonate, decreased mucosal blood flow)

9. Signs and Symptoms Symptoms depend on ulcer location, ulcer etiology, and patient age Many patients, particularly the elderly, have few or even no symptoms NSAID-induced ulcers are often silent Complications such as bleeding and perforation are often the initial presentation

10. Pain localized to the epigastrium is the most common symptom. The pain is described as burning, gnawing, cramping, or hunger. A typical nocturnal pain that wakes the patient from sleep (especially between 12 and 3am). The severity of ulcer pain varies from patient to patient and my be seasonal, occurring more often in the spring or fall.

11. Episodes of pain usually occur in clusters, lasting up to a few weeks followed by a pain-free period or remission lasting weeks to years. Changes in the character of pain may suggest the presence of complications. Pyrosis (heartburn), belching, and bloating may accompany the pain.

12. Complications Major complications of PUD include: Bleeding Occurs in about 15% of patients with active PUD Perforation Occurs in about 7% of patients with active PUD Mortality Mortality from acute bleeding is about 6% - 10%

13. Diagnostic Studies Endoscopy procedure Determines degree of ulcer healing after treatment Tissue specimens can be obtained to identify H. pylori and to rule out gastric cancer Tests for H.pylori Noninvasive tests Serum or whole blood antibody tests Immunoglobin G (I g G) Urea breath test C 14 breath test Invasive tests Biopsy of stomach Rapid urease test

14. Barium contrast studies Widely used X- ray studies Ineffective in differentiating a peptic ulcer from a malignant tumor Gastric analysis Lab analysis

15. Drug Therapy Antacids H 2 receptor blockers PPIs Antibiotics Anticholinergics Cytoproctective therapy

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