Peptic ulcer disease (PUD) is the presence of one or more ulcerative lesions in the stomach or duodenum. Etiologies include infection with Helicobacter pylori (most common), prolonged NSAID use (NSAID-induced ulcer), conditions associated with an overproduction of stomach acid (hypersecretory states), and stress. Epigastric pain is a typical symptom of PUD; however, many patients remain asymptomatic. Usually, patients younger than 60 years of age can be managed with a test-and-treat strategy for H. pylori infection or with empirical acid suppression therapy. Older patients and those with high-risk clinical features benefit from an esophagogastroduodenoscopy (EGD) and biopsies to confirm the diagnosis or rule out differential diagnoses (especially gastric cancer). First-line treatment for most peptic ulcers involves symptom control (e.g., acid-lowering medication), H. pylori eradication therapy, and withdrawal of causative agents. Antisecretory drugs (e.g., proton-pump inhibitors), which reduce stomach acid production, are continued for 4–8 weeks after eradication therapy and may be considered for maintenance therapy if symptoms recur. Surgical intervention may be considered in rare cases. Some patients benefit from endoscopic surveillance, especially if symptoms persist or there is clinical suspicion for malignancy. Peptic ulcer: a defect in the gastric or duodenal mucosa with a diameter of at least 0.5 cm and a depth that penetrates through the muscularis mucosae [1] Gastric ulcer: a peptic ulcer of the gastric mucosa, typically located along the lesser curvature in the transitional portion between the corpus and antrum Duodenal ulcer: a peptic ulcer of the duodenal mucosa, usually located on the anterior or posterior wall of the duodenal bulb

1. Peptic ulcer disease
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2. Definition
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❑Peptic ulcer are the open sores that occurs in
the lining of the stomach or small intestine. It is
the erosion of mucosal layer and break in the
lining of the stomach .
❑Peptic ulcer results from imbalance of protective
factors like bicarbonate ,mucus and damaging
factors like acid and pepsin.
❑Incidence of duodenal ulcer is more common
than gastric ulcer.

3. There are three types of peptic
ulcers;
❑Gastric ulcers : ulcers that
develop inside the stomach
❑Esophageal ulcers : ulcers that
develop inside the esophagus
❑Duodenal ulcers : ulcers that
develop in the upper section of
the small intestines, called the
duodenum
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4. Risk factors:
❑Smoking
❑Alcohol intake
❑Spicy food
❑Prolong use of NSAIDS(eg; paracetamol, ibuprofen)
❑H.pylori
❑Stress like major injuries,illness,tumour.
❑Gender: duodenal ulcer are increasing in older women.
❑Age duodenal:30-40 ,,Gastric over 50

5. Difference between gastric and duodenal ulcer
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Gastric.
1. They occur in stomatch.
2. They cause by injury like
Substances,alcohol,aspirin,NSAIDs,drugs.
3. Pain in left epigastric region in gastric
ulcer
4. Nausea is common, vomiting with
blood occurs in this case.
5. Weight loss, pain starts just after taking
food
6. Pain is present while hungry.
7.Malignancy is not common
Duodenal
1. They occur in duodenum
2. these are cause by HCl
secretion by vagus nerve
3. Pain in the right epigastric region
4. Stool with blood.
5. No weight loss,onset of pain
after 2-4hrs of taking food
6. Absent
7. Malignancy is common

6. Etiology
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❑Epigastric pain
❑Nausea
❑Vomiting
❑Dyspepsia
❑Bloating
❑Belching
❑Pain after food intake
❑Radiation therapy
❑Stomach cancer

7. Clinical manifestations
❑The most common symptom of a peptic ulcer is burning abdominal pain that extends
from the navel to the chest, which can range from mild to severe. In some cases, the pain
may wake you up at night. Small peptic ulcers may not produce any symptoms in early
phases.
❑Other common signs of a peptic ulcer include;
❑Changes in appetite
❑Nausea
❑Bloody or dark stools
❑Unexplained weight loss
❑Indigestion
❑Vomiting
❑Chest pain
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8. Complications
❑Perforation leading to peritonitis
❑Haemorrhage by erosion of vessel in base.
❑Penetration of surrounding organ (liver/pancreas)
❑Obstruction (by scarring) - pyloric stenosis ( cancer – rare
event in true peptic ulcer )
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9. Diagnostic tests
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❑Medical history
❑Physical exam
❑Lab tests
• Stool examination for fecal occult blood
• Complete blood count for decrease in blood cells.
❑Upper gastrointestinal endoscopy and biopsy
❑Upper GI series
❑Computerised tomography scan

10. Lifestylemodification
❑Discontinue NSAIDs
❑Smoking cessation
❑Alcohol cessation
❑Stress reduction
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11. Drug management
❑Antibiotic medications to H. Pylori.
If H.pylori is found in your digestive tract, the doctor may recommend a
combination of antibiotics to kill the bacterium. These include
amoxicillin,clarithromycin,methronidazole.
❑Proton pump inhibitors
Also called PPIs reduce stomach acid by blocking the action of the parts of cells that
produce acid. These drugs include the prescription and over the counter
medications like omeorazole,lansoprazole.
❑ Acid blockers
Also called histamine blockers,reduce the amount of stomach acid released into your
digestive tract, which relieves ulcer pain and encourages healing eg; ranitidine
❑Antacids
Neutralize existing stomach acid and can provide rapid pain relief.side effects can
include constipation or diarrhoea, depending on the main ingredients.
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12. ❑Vagotomy
❑Pyloroplasty
❑Subtotal gastrectomy
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Surgical treatment

13. ❑H. Pylori is the most common cause of
PUD and is a risk factor for gastric
cancer.
❑H.pylori eradication reduces the risk of
the disease reoccurrence
❑Test and test strategy is recommended
for patients with undifferentiated
dyspepsia
❑Initial evaluation with endoscopy is
recommended for those with alarm
symptoms or those failing treating
❑Optimum treatment regimens are 14d
multidrug with antibiotics and acid
suppressants (triple therapy)
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Summary

14. Thank you
Brincelet m biju