This document discusses peptic ulcers, including their definition, types, causes, signs and symptoms, diagnosis, pathogenesis, differential diagnosis, allopathic management, and holistic management approaches like diet therapy, acupuncture, hydrotherapy, chromotherapy, massage therapy, herbal remedies, and yoga therapy. The holistic approaches aim to promote healing and repair of damaged tissue through strategies like probiotics, antioxidants, dietary polyphenols, and protective foods.

1. By
Deepika Vashisth
BNYS IV Year

2. INTRODUCTION
 Naturally the stomach produces gastric acid and
pepsin to aid the process of digestion.
 The stomach has a mucosal barrier to protect itself
from the deleterious effect of the acid, churning
process of food digestion and other external
influences.
 An acid pepsin disorder occurs when the injurious
effects of acid and pepsin overwhelm the mucosal
barrier of the stomach by eroding it.

3. DEFINITION
 Ulcerated lesion in the mucosa of the stomach or the
stomach or duodenum.
or
 Peptic ulcer is define as disruption of the mucosal
integrity of the stomach / duodenum leading to a local
defect due to active inflammation. It can also be termed
as a break in the mucosal surface great3r then 5mm in
size.

4. TYPES
 Gastric ulcer
 Duodenal ulcer

7. EPIDEMIOLOGY
 Middle age to older age.
 Peptic ulcer – first portion of the duodenum or in the
stomach, in a ratio of about 4:1 .
 Male/female ratio is 3:1 .

8. CAUSES OF
PEPTIC ULCER

10. SIGNS AND
SYMPTOMS OF
PEPTIC ULCER

11. Signs and symptoms
 Epigastric pain
 Pain or discomfort in the upper abdomen
 Belching
 Significant weight loss
 Stool discoloration
 Nausea
 vomiting
 Heart burn
 Indigestion
 Loss of appetite

13. PATHOGENESIS

15. IMBALANCE ACID SECRETION

16. DIFFERENTIAL
DIAGNOSIS

17. DIFFERENTIAL DIAGNOSIS
 Gastritis
 Stomach cancer
 Gastro esophageal reflux disease (GERD)
 Gastroenteritis
 Acute pancreatitis
 Non-ulcer dyspepsia
 Esophageal cancer
 Esophagitis

19. DIAGNOSIS
Medical history:-
 The characteristic feature in the diagnosis of peptic ulcer
is based on sign and symptoms.
Complications:-
 Peptic ulcer may be asymptomatic.
 Perforation.
 Peptic ulcer- sudden symptoms of hematemesis and
melaena may be the sign of perforation.

20. Physical examination:-
 Inspection-
 Check for blotting
 Palpation
 Epigastric tenderness
Auscultation:-
 Sucussion splash(presence of gas and fluid, as in gastric
outlet obstruction) may be heard in patients with pyloric
stenosis.

21.  Investigation:-
 CBC - for ruling out anemia or any evidence of
gastrointestinal bleeding.
 Urea breath test and stool test- for presence H. pyloric
 Endoscopy and biopsy - to check ulcer and malignancy

22. NATUROPATHIC UNDERSTANDING
OF PEPTIC ULCER

23. Natural protection of mucous membrane
right food Good amount of water Frequent changes of
mucous membrane Bile secretion
When these mechanism fail
Wrong food habit , less water consumption, bile
regurgitation
There exist persistent inflammation
irritation
inflammation

24. Hardening of that surface and subsequent
tissue break down
Blocks arterial circulation and terminate oxygen
supply to the area
Break down of the tissue
Ulcer formation
induration
ulceration
Proper life style Further violation of
natures law
healing cancer

25. MANAGEMENT
THROUGH
HOLISTIC
VIEW

26.  Antibiotics
 Proton pump inhibitor
 H2 blocker
 Antacids
 Surgery:-when medication don’t respond such as in
perforation.
ALLOPATHY MANAGEMENT

27. DIET THERAPY
Aim:-
 To promote healing and repair the damage tissue.
 PROBIOTICS:-
Definition:-
 Probiotics are live bacteria that are very useful in
maintenance gut health.
 Lactobacillus and bifidobacterium are beneficial in
treating GI disorders.

28. Activity:-
 Probiotic help in the suppression of pathogenic
bacteria in the gut and facilitate anti-inflammatory
changes.
 The role of lactobacillus is been study and found useful
in promoting gastric ulcer healing by regeneration of
epithelial cells in rat.
 It also helping maintaining the integrity of mucosal
barrier by upregulating prostaglandin mucous
secretion and by inhibiting apoptosis

29. Common probiotics:-
 Yoghurt / curd
 Cabbage juice
 Knol khol
 Nut milk

30. ANTIOXIDANTS:-
 Spices and herbs have useful antioxidant that can help
in prevention of oxidative stress.
 Anti-ulcerogenic effect is due to presence of flavonoids
and other polyphenols.
Common antioxidants:-
 Fruits and vegetable (rich in vitC )
 Capsaicionoids(present in capsicum)
 Wheatgrass.

31. DIETARY POLYPHENOLS:-
 It exhibit protective and therapeutic effect in peptic
ulcer due to
 upregulation of growth factors and prostaglandin,
 enhance angiogenesis,
 improve cytoprotection,
 improve antioxidant,
 antacid and antisecretory activity,
 improved mucosal defense,
 blocking of H. pyloric

32.  A Balance diet of fruits and vegetables including
 Apple
 Grapes
 Pineapple
 Curcumin
 ginger
.
help in prevention and
management of peptic ulcer.

33. PHOSPHOLIPIDS AND STEROLS:-
 Helps in preventing intracellular acidification by
improving viscosity of mucus layer.
 Phospholipids such as phytosterols have anti-
inflammatory properties.
 Phospholipids and phytosterol exhibit protective
activity.

34. Common phospholipids:-
 Rice bran oil.
 Wheat bran oil.
 Unrefined wheat.
 Ginger oil.
 Millets.
 Maize.
 Soya.
 Pluses(horse gram)

35. PROTECTIVE FOODS:-
 Yoghurt
 Flaxseed.
 Walnut.
 Apple
 Papaya
 Melon
 Banana
 Dark green leafy vegetables
 Carrot
 Beet
 Radish
 Cabbage
 soybeans

36. CONTRAINDICATD FOODS:-
 Fried food
 Spicy peppers(black pepper, chilli)
 Chocolate
 Coffee
 Cola drinks
 Preserved and stored food.

37. ACUPUNCTURE
 CV 12
 ST 36
 Elcro-acupuncture:-
 ST 2
 ST 25
 ST 36
Main points
improve gastric mucosal blood flow regulates the
concentration of motilin and somatostatin in
sinus ventriculi and bulbus medullae.

38. Motilin:-
 It is a polypeptide that regulates gastric motility.
 Induce smooth muscle contraction of sinus ventriculi
and segmentation movement of intestine.
 Promote movement of colon and bladder
Somatostatin:-
 Inhibitor of gastric function.(decreases gastric
secretion).

39. HYDROTHERAPY
Gastro hepatic compress:-
 duration - 30min.
 action – to reduces congestion over abdominal
area(which is the main reason of inflammation
and indurations.)
Hot and cold application over lumbar and hypo-
gastric region.
 action– derivative and reflex effect.

40. 
 duration – 20min.
 Action – enhances blood flow.
removes pain producing chemicals
(algogenic chemicals).
facilitates muscle relaxation.

41. Cold abdominal pack and steam bath
 action – helps to produce prostaglandin to induce
epithelial cell proliferation.

42. MUD THERAPY
Cold mud pack:-
 influence prostaglandin and leukotrienes, which
prevent unwanted aggregation of platelets which
result sclerosis.

43. HELIOTHERAPY
 Sun exposure- reduce incidence of GI disorder
especially cancer.
 It reduces oxidative stress – which is involved in the
pathogenesis of acute gastric injury and apoptosis.
 Vit D3 counteract intracellular cell death and improve
epithelial regeneration
 duration – 15 to 20 min.

44. CHROMOTHERAPY
 Green color:-
 it restores the balance in the body.
 germicidal effect.
 readjust the metabolic rate and glandular secretion.

45. MASSAGE THERAPY
 Psychological and physical factor can lead to peptic
ulcer.
 Massage therapy exhibits dualistic therapeutic
potential and deals with root of peptic ulcer.
 benefits
 Reduces anxiety, tension, and perceived stress.
 Improvement in mental wellbeing and coping efficacy

46. HERBAL REMEDIES
 Indian bael:-
scientific name – Aegle marelose.
dose – orally (21 days 1gm/kg body wt.)
 Garlic
scientific name – Allium sativum.
The extract of its bulb is known to increase healing
of gastric ulcer.

47.  Aloe vera:-
Oral intake has significant anti ulcer activity
 Custard apple, (sitaphal):-
Scientific name – Annona squamosa
The extract of leaves is known to heal gastric ulcer

48. YOGA THERAPY
 Stress play a major role in development and
exacerbation of GI disorders like GERD, peptic ulcer,
IBS etc.
 Yoga practice regulates inappropriate in autonomic
function in peptic ulcer patient and improve their
physiological and psychological profile

49. ASANAS:-
 Vajrasana
 Shashankasana
 Padahastasana
 Ardhkati chakrasana
 Vakrasana
 Trikonasana

51. Kriyas:-
 Kapalabhati
 Agnisara
Pranayamas:-
 Nadishuddhi
 Sheetli
 sheetkari
 bharmari

52. FOLLOW-UP MEASURES
 Intake of high fiber in natural form (fruits and
vegetables)
 Carbonated drinks caffeine, alcohol, preserved food
should be avoided.
 Intake of ash gourd juice in the morning can prevent
progression of inflammation to ulcer