BAQAI MEDICAL UNIVERSITY CLINICAL PHARMACY

2. INTRODUCTION
PATHOGENESIS
GENERAL SYMPTOMS
CAUSES
LABORATORY TESTS
RISK FACTORS
TREATMENT
COMPLICATIONS
PREVENTION

4. Peptic ulcers are sores that
develop in the lining of the
stomach, lower esophagus, or
small intestine.
They’re usually formed as a result
of inflammation caused by the
bacteria H. pylori, as well as from
erosion from stomach acids.

5. A) Depending On The Site
B) Depending On The
Duration

6. a) DEPENDING ON THE
SITE
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.

7. 1. Gastric ulcers that occur on
the inside of the stomach.
Gastric ulcers are less
common than duodenal
ulcers.
They affect older age
group.
NSAID’S are common
cause of gastric ulcers.

8. 2. Duodenal ulcers that occur
on the inside of the upper
portion of small intestine
(duodenum).
All duodenal ulcers occur in
duodenal bulb. This part of
duodenum is in the direct
path of the acid contents of
stomach.
They tend to occur in
younger patients and more
common in men than in
women.

9. 3. ESOPHAGEAL ULCER is a painful sore
located in the lining of the lower part of the
esophagus.
Esophageal ulcers usually form as a result
of an infection with a bacterium
called helicobacter pylori.

12. Although the prevalence of peptic
ulcer is decreasing in many
western countries it still affects
approximately 10% of all adults at
some time in their lives. The male
to female ratio for duodenal ulcers
varies from 5:1 to 2:1 while for
gastric ulcers is 2:1 or less.

13. ACUTE PEPTIC ULCER
CHRONIC PEPTIC ULCER
b) DEPENDING ON THE
DURATION:

14. DIFFERENCE BETWEEN ACUTE
AND CHRONIC PUD:

17. Burning Stomach Pain.
Feeling Of Fullness, Bloating.
Fatty Food Intolerance.
Heartburn.
Nausea.
Pain Worse Between Meals And At Night.
Ulcers May Cause Severe Signs Or
Symptoms Such As:
Vomiting Or Vomiting Blood — Which May
Appear Red Or Black.
Dark Blood In Stools.
Trouble Breathing.
Feeling Faint.
Unexplained Weight Loss.
Appetite Changes.

18. CAUSES
Rare cancerous and non-cancerous tumors
in the stomach, duodenum, or pancreas—
as Zollinger-Ellison syndrome
An infection
with Helicobac
ter pylori (H.
pylori)
Long-term use
of NSAIDs,
as aspirin and
ibuprofen.

19. H.PYLORI
H. Pylori are gram-
negative, spiral & have
multiple flagella at one
end. Transmitted from
person-to-person by oro–
oral or feco-oral spread .
H. Pylori bacteria can
cause peptic ulcer disease
by damaging the mucous
coating that protects
lining of stomach and
duodenum.

20. NSAID
Nonsteroidal anti-
inflammatory drugs
reduce pain, fever &
inflammation, or swelling.
NSAIDS blocks or reduce
amount of prostaglandin
that body makes.
These drugs also generate
oxygen-free radicals &
products of the
lipoxygenase pathway that
may contribute to
ulceration.

21. ZOLLINGER ELLISON
SYNDROME
Zollinger-Ellison
syndrome is a rare
disorder.
The tumors release large
amounts of gastrin, a
hormone that causes
your stomach to produce
large amounts of acid.
The extra acid causes
peptic ulcers to form in
your duodenum and in
the upper intestine.

23. To help diagnose a peptic
ulcer, your doctor will ask you
questions about your medical
history, symptoms, and
medicines you take.
Be sure to mention medicines
that you take without a
prescription, especially
NSAIDS such as
ASPIRIN (bayer aspirin)
IBUPROFEN (motrin, advil)
MEDICAL HISTORY

24. If you have a (H. Pylori) infection,
your doctor will order these
tests:
1. BLOOD TEST:
A blood test involves drawing a
sample of your blood at lab.
A health care professional tests
the blood sample to see if the
results fall within the normal
range for different disorders or
infections.

25. 2. UREA BREATHE TEST:
For a urea breath test, you will
drink a special liquid that
contains urea,.
If H. pylori are present, the
bacteria will change this waste
product into carbon dioxide—a
harmless gas.
If your breath sample has
higher levels of carbon dioxide
than normal, you have H.
pylori in your stomach or small
intestine.

26. 3. STOOL TEST:
Doctors use a stool test to study a
sample of your stool.
A doctor will give you a container for
catching and storing your stool at home.
You return the sample to the doctor or a
commercial facility, who then sends it to
a lab for analysis. Stool tests can show
the presence of H. Pylori.

27. 4. UPPER GI ENDOSCOPY:
More reliable method and visual diagnosis.
An intravenous (IV) needle will be placed in
your arm to provide a sedative. Sedatives
help you stay relaxed and comfortable
during the procedure.
The doctor may perform a biopsy with the
endoscope by taking a small piece of tissue
from the lining of your esophagus.

28. 5. UPPER GI SERIES:
During the procedure, you’ll stand or sit
in front of an x-ray machine and drink
barium, a chalky liquid. Barium coats
your esophagus, stomach, and small
intestine so your doctor can see the
shapes of these organs more clearly on
x-rays.

29. 6. H.PYLORI TESTING:
Invasive tests using an
endoscopy procedure are less
frequently performed than
non-invasive tests as they
require a tissue biopsy
collection. Tests include:
Histology – examination of
tissue under a microscope.
Rapid urease testing – detects
urease, an enzyme produced
by H. Pylori which lead to
change a ph.
Culture – growing H.
Pylori in/on a nutrient
solution.

31. 1) H2 RECEPTOR
BLOCKERS

33. Treatment goals
in acute setting
are relief of
discomfort and
protection of the
gastric mucosal
barrier to
promote
healing.
Anti-ulcer drugs
are classified as:
ANTI-ULCER DRUGS
H2 RECEPTOR
BLOCKER
PROTON PUMP
INHIBITOR (PPI)
ANTACID
ULCER
PROTECTIVE
AGENTS
ANTI H.PYLORI
DRUGS

34. Dizziness
Bowel Upset
Headache
Constipation
SIDE EFFECTS
DRUG
INTERACTION
It Inhibit metabolism of many drugs
so that they accumulate to toxic level.
E.g warfarin, phenytoin etc.

35. Cimetidine (tagamet)
Ranitidine (zantac)
Famotidine (pepcid)
EXAMPLES

36. 2) PROTON PUMP
INHIBITOR (PPI)

37. Omeprazole (Prilosec, Prilosec )
Lansoprazole (Prevacid, Prevacid )
Rabeprazole (Aciphex)
EXAMPLES:

38. 3) ANTACIDS

39. Constipation (caused by
aluminum-containing
antacids).
Diarrhea (caused by
magnesium-containing
antacids).
SIDE EFFECTS
DRUG
INTERACTION
Certain medications may cause complications
when taken with antacids or acid reducers,
particularly those that require an acidic
environment in the stomach for absorption
like aspirin.

40. Alka-seltzer
Milk Of Magnesia
Amphojel
EXAMPLES:

41. 4) ULCER
PROTECTIVE
DRUGS

42. .
DRUG
INTERACTION:
Activated by acid,Don't take with H2 blockers or
antacids, which reduce the acidic environment
required for activation of these drugs.

43. Sucralfate (Carafate)
Misoprostol (Cytotec)
EXAMPLES:

44. 5) ANTI H. PYLORI
DRUGS

45. The treatment regimens are omeprazole,
amoxicillin, and clarithromycin (OAC)
for 10 days.
Bismuth subsalicylate, metronidazole,
and tetracycline (BMT) for 14 days.
TREATMENT
REGIMEN

46. A. PERFORATION:
A hole develops in
the lining of the
stomach or small
intestine and
causes an infection.

47. Sign of a
perforated ulcer
is sudden, severe
abdominal pain.

48. B. INTERNAL
BLEEDING:
Bleeding ulcer can
result in significant
blood loss and thus
require
hospitalization.
Signs of a bleeding
ulcer include
lightheadedness,
dizziness, and black
stools.

49. C. SCAR TISSUE:
This is thick tissue that
develops after an injury.
This tissue makes it
difficult for food to pass
through your digestive
tract.
Signs of scar tissue
include vomiting
and weight loss.

50. D. GASTRIC OUTLET
OBSTRUCTION:
They can also cause scar
tissue, swelling or scar
tissue can obstruct the
normal passage of food
through digestive tract.
This obstruction can
cause reported episode
of vomiting .

51. AVOID
TOBACCO
PRODUCTS
AVOID
ALCOHOL
USE
CAUTION
WITH
ASPIRIN
AND/OR
NSAIDS
WASH
HANDS
REGULARL
Y
To reduce risk of
developing a peptic ulcer,