SESSION 13. Peptic ulcer disease.pptbbbbbx

education

1. SESSION 13: PEPTIC ULCER DISEASE

2. Learning objectives At the end of this session each participant should be able to; Define Peptic ulcer disease Describe pathogenesis of Peptic ulcer disease Explain clinical features of Peptic ulcer disease Explain complications of Peptic ulcer disease Describe management Peptic ulcer disease Provide measures to prevent and control of Peptic ulcer disease

3. Peptic ulcer disease (PUD) Peptic ulcer also known as gastric ulcer is a circumscribed loss or Break in the mucosa (of esophagus, Stomach, duodenum) After exposure to acid‐peptic activity they extends deep into the muscularis and are associated with an acute or chronic inflammatory cell infiltrate. But an ulceration which doesn’t reach the muscularis mucosa is called erosion. Main causes of Peptic ulcer disease (PUD) are; Helicobacter Pylori infection: Cause 90% of all duodenal ulcers, Cause 70% of all gastric ulcers , NSAID use, inhibit prostaglandin production, which leads to impaired mucosal defenses Acid hyper secretion (Gastrinoma / Zollinger‐ Ellison), Alcohol and Smoking Malignancy, Stress related (ICU patients, stroke, ventilator dependence, immunocompromised)

4. Clinical Features Normally when there is food in the stomach, gastrin stimulates the release of gastric acid for digestion, when plasma amino acids, fatty acids, and glucose level increase after absorption, somatostatin is secreted to inhibit the release of more Acid . H. pylori and NSAIDs both disrupt the mucosal layer. H. pylori also decreases somatostatin secretion, and thus cause PUD Signs and symptoms depend on the area of the brain affected, these include; Epigastric pain Aching or gnawing OR burning in nature Shortly after meals with gastric ulcer 2‐3 hours after ward with duodenal ulcer. May be complicated by upper GI bleeding Other symptoms: nausea/vomiting, early satiety, and weight loss Dyspepsia, Heartburn, bloating, abdominal distention, Chest discomfort Hematemesis or melena resulting from gastrointestinal bleeding. Symptoms consistent with anemia ( eg , fatigue, dyspnea) Sudden worsening of symptoms may indicate perforation. NOTE; Food may relieve pain of duodenal ulcers but not gastric ulcer pain.

5. Investigations Basing on medical history and symptoms the following investigation should be done; Helicobacter pylori test Rapid urease tests Oesophageal gastro duodenoscopy(OGD) Histopathology Blood Culture and sensitivity Fecal antigen test for H pylori Full blood picture and differential Haemoglobin level

6. Management of PUD. There are two modalities of treating PUD of H pylori; PPI‐based triple therapy regimens for H pylori consist of a PPI, amoxicillin, and clarithromycin for 14 days. Omeprazole : 20 mg PO twice daily Clarithromycin : 500 mg PO twice daily Amoxicillin : 1 g PO twice daily OR Omeprazole : 20 mg PO twice daily Clarithromycin : 500 mg PO twice daily Metronidazole : 500 mg PO twice daily Quadruple treatment includes the following drugs, administered for 14 days. PPI, standard dose, or ranitidine 150 mg, PO twice daily Bismuth 525 mg PO four times daily Metronidazole 500 mg PO four times daily Tetracycline 500 mg PO four times daily NOTE; Quadruple therapies for H pylori infection are generally reserved for patients in whom the standard course of treatment has failed.

7. Evaluation Define Peptic ulcer disease Outline risk factors of Peptic ulcer disease Outline complications of Peptic ulcer disease Provide measures to prevent and control of Peptic ulcer disease

8. References Davidson, S, (2014) - Principles and Practice of Medicine, 22nd Edition, Churchill Livingstone. Longmore , M, et al, (1999), Oxford Handbook of Clinical Medicine, 6th Edition, Oxford Swash, M., & Glynn, M. (2007). Hutchinson’s Clinical Methods: An Integrated Approach to Clinical Practice: 22nd Edition. Philadelphia, PA: Saunders Elsevier Trouse , (2000) Short textbook of Medicine University Press MoHCDGEC Standard treatment guidelines & national essential medicines list tanzania mainland 2017 MoHCDGEC/ NACTE (2016). Curriculum for Technician Certificate (NTA Level 5) Curriculum, Dodoma.