Causes, symptoms, and treatment of gastric and duodenal ulcers...

1. Peptic Ulcer
BY: Syeda Aiman

2.  Overview
 Symptoms
 Causes
 Risk Factors
 Complications
Objectives :
 Diagnosis
 Epidemiology
 Treatment
 Prevention

3. Overview

4. SYMPTOMS
:

5. Causes of Peptic Ulcer
 Infection of gastric mucosa with Helicobactor pylori bacteria:
This is the main cause of peptic ulcer in most cases.
The bacteria lives within the mucous layer, it protects itself from the effects of the
gastric acid reaching it by releasing the enzyme urease; this enzyme converts
urea into ammonia and bicarbonate, both of which are basic substances that
neutralize the acid.
On the other hand, its presence within the mucous layer protects it from the
immune system of the body.
Ammonia and the products of leukocytes which attach the bacteria result in
disruption of the mucosal barrier or direct damage to the gastric mucosa causing
peptic ulcer

6. Causes
 Nonsteriodal anti-inflammatory drugs (NSAIDS) like aspirin
This inhibit synthesis of prostaglandins from arachidonic acid.
Since prostaglandins inhibit HCL synthesis and increase mucus secretion, then
chronic use of aspirin, which inhibits its formation from arachidonic acid, results
in increased HCL secretion and decreased mucus production causing peptic
ulcer.
 Zollinger Ellison syndrome
Describe by Zollinger and Ellison in 1955
Caused by tumor in the pancreas or other part of the GIT
The tumor cells release gastrin (=gastrinoma). This cause excessive secretion of
HCL resulting in multiple peptic ulcer.

7. RISK FACTORS
:
1. Frequent use of nonsteroidal anti-inflammatory drugs (NSAIDs), a group of
common pain relievers that includes ibuprofen (Advil or Motrin )
2. A family history of ulcers
3. Illness such as liver, kidney or lung disease
4. Excess consumption of alcohol
5. Smoking

8. COMPLICATION
S
-Internal bleeding:
ulcer erodes gastric arteries {hemorrhage}
-Perforation in stomach wall:
a hole allowing gastrointestinal contents into
peritoneal space {peritonitis}
-Gastric outlet Obstruction:
peptic ulcer can block passage of food causing
the feeling of fullness, and vomiting which leads to
weight loss
-Gastric cancer:
most common cause is infection by bacterium
helicobacter pylori

9. Diagnosis
Non-invasive techniques
 Blood test: blood sample is taken
from the patient’s vein and tested for
H.pylori antibodies
 Urea breath test patient swallows a
capsule containing urea “labelled”
with a special carbon atom and
breathes into a container, exhaling
carbon dioxide. Exhaled breath
contains carbon atom H.pylori is
present
 Stool antigen test patient provides a
stool sample : H pylori antigens

10. Invasive techniques
 Endoscopy : doctor can closely examine the lining of
the esophagus, stomach, and duodenum
 X- ray: you will be given a contrast liquid to drink
called barium, a thick, white, milkshake- like liquid .
Barium coats the inside lining of the esophagus,
stomach and small intestine, and makes them
easier to see clearly on X- rays

11. EPIDEMIOLOGY OF PEPTIC ULCER
DISEASE
 Prevalence: 12% of men and 10% of women in US
 Global incidence and prevalence of peptic ulcer have been in decline over past couple of
decades
 Four times as many duodenal ulcers as gastric ulcers are diagnosed in us, elsewhere
gastric ulcers are more common
 H.Pylori = main factor for
90% duodenal ulcers
80% gastric ulcers

12. Age and gender distribution of persons
with peptic ulcers
• Duodenal ulcers appear between ages
30-50 and are more common in men
than women
• Stomach ulcers occur later in life,
after age 50 , affect women more
often than men.
• Prevalence of peptic ulcer disease
has shifted from predominance in
males to similar occurences in
males and females.

13. - Data shows that incidence of peptic ulcer has decreased over recent decades in many
countries, particularly in western populations (as a result of decrease in H.pylori infection)
-Peptic ulcers remain a relatively common condition worldwide (especially in developing
countries )

14. Treatment
 Treatment for peptic ulcers depends on the cause.
Usually treatment will involve killing the H.pylori bacterium if
present, eliminating or reducing use of NSAIDs if possible, and
helping your ulcer to heal with medication.
Medications can include :
1.Antibiotic medications to kill H.pylori found in digestive tract,
doctor may recommend a combination of antibiotics to kill the
bacterium. These may include amoxicillin (Amoxil), clarithromycin
(Biaxin), metronidazole (Flagyl).
 Antibiotics will be taken for two weeks, as well as additional
medications to reduce stomach acid.

15. Treatment
2. Medications that block acid production and promote healing.
Proton pump inhibitors - also called PPIs – reduce stomach acid by
blocking the action of the parts of cells that produce acid
 Long-term use of proton pump inhibitors, particularly at high doses,
may increase your risk of hip, wrist and spine fracture.
3. Medications to reduce acid production.
Acid blockers – also called histamine (H-2) blockers
Reduce the amount of stomach acid released into your digestive
tract, which relieves ulcer pain and encourages healing

16. Treatment
4. Antacids that neutralize stomach acid.
Doctor may include an antacid in drug regimen. Antacids neutralize
existing stomach acid and can provide rapid pain relief. Side effects
can include constipation or diarrhea, depending on the main
ingredients.
In some cases, doctor may prescribe medications called
cytoprotective agents that help protect the tissues that line the
stomach and small intestine
 Options include the prescription medications sucralfate (Carafate)
and misoprostol (Cytotec)

17. Prevention of peptic ulcer
 To reduce your risks of developing peptic ulcer:
- Avoid tobacco products
- Avoid alcohol
- Use caution with Aspirin and NSAIDs
- Don’t ignore your ulcer symptoms
- Protect yourself from infections by washing hands
regularly
- Eat balanced diet rich in fruits, vegetables, and whole
grains

18. THANK YOU!
