Peptic ulcer.pptx

Ulcer, Etiology of peptic ulcer , pathophysiology, clinical manifestations, Treatment. B.pharm D.pharm Pharmacology

1. GASTRO-INTESTINAL DISORDERS PEPTIC ULCER A PRESENTATION BY AMAN GUPTA LECTURER GCRG COLLEGE OF PHARMACY

2. PEPTIC ULCER Peptic= refers to pepsin; Pepsin is an enzyme that breaks down proteins and is responsible for protein digestion. It only gets activated in acidic environment. Ulcer= Sore, wound or a break/injury in mucous membrane. Definition: Peptic ulcers are the lesions ( sores\wound) that develop in the mucosal lining of the stomach, lower esophagus, small intestine or any other part of GIT. Or Peptic ulcer is a lesion in the lining (mucosa) of the digestive tract, typically in the stomach or duodenum, caused by the digestive action of pepsin and stomach acid.

3. TYPES OF ULCERS Generally, ulcers occur in three parts of the Gastro-intestinal tract and are classified according to them: Gastric ulcers: Gastric ulcers develop on the inner lining of the stomach. They occur when the mucus layer of the stomach that protects stomach from digestive juices and acids is reduced. It allows the digestive acids to destruct the tissues that line the stomach, causing an ulcer. Esophageal Ulcers: Esophageal ulcers develop inside the esophagus. If the lower esophageal sphincter (LES) does not close properly then stomach acid can leak back into the esophagus This causes chronic inflammation and irritation of the esophagus, allowing ulcers to develop. Duodenal Ulcers: Duodenal Ulcers develop on the inside of the upper part of the small Intestine, known as the duodenum. It is the most common type of peptic ulcer.

4. ETIOLOGY OF PEPTIC ULCER Following factors can lead to the development of ulcer: Gastric enzymes and acids: Gastric acid is required for the activation of gastric enzymes and proper digestion of food. Sometimes, this gastric acid may cause irritation and corrosion in the mucous membrane of the stomach, duodenum or esophagus. Helicobacter pylori infection: Helicobacter pylori infection occurs when H. pylori bacteria infects the GIT. H. pylori bacterium produces an enzyme ‘urease’. This urease splits urea into ammonia and CO2. The ammonia thus produced is toxic to the epithelial cells and damages the stomach lining leading to ulcer. Regular use of NSAIDs: NSAIDs are well known for development of peptic ulcer. Aspirin , as well as certain over-the-counter and prescription pain medications called non steroidal anti-inflammatory drugs (NSAIDs) can irritate or inflame the lining of the stomach and small intestine. These medications include ibuprofen, naproxen sodium, ketoprofen and others . Obesity. Smoking. Alcohol consumption. Excessive consumption of oily foods.

5. PATHOPHYSIOLOGY OF PEPTIC ULCER In GIT, two types of factors are present: Aggressive factors[such as gastric acid, pepsin, h. pylori etc] mainly required for food digestion. Protective/Defensive factors[such as mucous membrane, sodium bicarbonate etc] to protect GIT lining from corrosive action of gastric acid. In normal condition, there is always a balance between these two factors. Imbalance between these two factors leads to Peptic ulcer. Aggressive factors Defensive factors

6. PATHOPHYSIOLOGY OF PEPTIC ULCER Increase in aggressive factors[Gastric acid/NSAIDs/H. pylori etc.] Decrease in defensive factors[Mucous/Bicarbonate etc.] This imbalance leads to corrosion of GIT lining due to gastric acid and causes irritation in GIT mucosa. Irritation and Corrosion leads to sore/ulcer. Peptic Ulcer

7. CLINICAL MANIFESTATIONS OF PEPTIC ULCER The most common peptic ulcer symptom is burning stomach pain in the middle of the abdomen. Other common symptoms of ulcers include: Feeling of fullness . bloating or belching. Intolerance to fatty foods. Heartburn. Loss of weight. Not willing to eat due to pain.. Vomiting. Dark blood in stools . Appetite changes.

8. DIAGNOSIS OF PEPTIC ULCER Endoscopy: A small lighted tube is put with a tiny video camera on the end (endoscope) into the git to look for inflammation or irritation of the tissue. Upper GI Series: It's a special X-ray that shows your esophagus, stomach, and the upper part of your small intestine (duodenum ). Blood test: To check H. pylori infection. Stool test

9. TREATMENT OF PEPTIC ULCER Non-pharmacological treatment: Non-pharmacological treatment of ulcers involves: Protect yourself from infections. Withdrawal of agents which cause ulcers such as NSAIDs. Avoid smoking. Avoid excessive intake of coffee. Avoid alcohol. Control stress. Pharmacological treatment: Cytoprotective drugs: These drugs have mucosal protective properties. Examples: sucralfates, bi-chelates, misoprostol and antacids like sodium bicarbonates. Antibiotics : T o kill H. pylori bacterium. Example: amoxicillin, metronidazole. Antisecretory drugs: These drugs reduce gastric acid secretion. H2-blockers : Ranitidine, Cemitidine, Famotidine, Nizatidine . Proton-pump inhibitors: Omeprazole, Pantoprazole, Lansoprazole, Rabeprazole.

10. THANK YOU