This document summarizes various acid peptic diseases. It defines acid peptic disease as a collection of diseases involving excessive acid secretion or diminished mucosal defense in the stomach and nearby gastrointestinal tract. It then briefly describes several conditions under this category including gastroesophageal reflux disease (GERD), gastritis, gastric ulcer, duodenal ulcer, esophageal ulcer, Zollinger-Ellison syndrome, and Meckel's diverticulum ulcer. For each condition, it provides details on symptoms, causes, diagnostic methods, and treatment approaches.

1. Acid
Peptic
Disease
Dr. Aneesh M. S
Asst. Professor
Department of Kayachikitsa
VAC Ollur

2. Digestion

3. Peptic -Acid

4. Acid Peptic Disease
• “Peptic” - relating to or promoting digestion
• Acid- Acid secretion & regulation related
• also known as acid peptic disorders
• collection of diseases involving acid production in the stomach
and nearby parts of the gastrointestinal tract

5. Acid Peptic Disease
• pathogenic mechanisms leading to either excessive acid secretion or
diminished mucosal defense
• Gastroesophageal Reflux Disease
• Gastritis
• Gastric Ulcer
• Duodenal Ulcer
• Esophageal Ulcer
• Zollinger–ellison Syndrome
• Meckel's Diverticulum Ulcer.

6. Gastroesophageal Reflux Disease
1. Gastroesophageal reflux disease (GERD) or gastro-oesophageal reflux
disease (GORD)
2. chronic diseases where stomach content persistently and regularly
flows up into the esophagus
3. Common symptoms
• acidic taste in the mouth
• Regurgitation
• heartburn.
4. Less common symptoms
• pain with swallowing/sore throat
• increased salivation (also known as water brash)
• Nausea
• chest pain
• Coughing
• globus sensation

7. Gastroesophageal Reflux Disease
• The acid reflux can induce asthma attack
• GERD sometimes causes injury to the esophagus.
1. Reflux esophagitis – inflammation of esophageal epithelium which can
cause ulcers near the junction of the stomach and esophagus
2. Esophageal strictures – the persistent narrowing of the esophagus caused
by reflux-induced inflammation
3. Barrett's esophagus – intestinal metaplasia (changes of the epithelial cells
from squamous to intestinal columnar epithelium) of the distal esophagus
4. Esophageal adenocarcinoma – a form of cancer
• GERD sometimes causes injury of the larynx (LPR)

8. Treatment - GERD
1. Medical nutrition therapy and lifestyle changes
2. Medications
3. primary medications used for GERD are
4. proton-pump inhibitors-
• eg., omeprazole
• twice a day.
• one half to one hour before a meal.
• Targeting the terminal step in acid production
5. H2 receptor blockers
• are a type of antihistamine
• block the action of histamine at the histamine H2 receptors of the parietal cells
• ranitidine
6. antacids with or without alginic acid

9. Gastritis
• inflammation of the lining of the stomach
• may occur as a short episode or may be of a long
duration.
• the most common is upper abdominal pain
• nausea and vomiting, bloating, loss of appetite
and heartburn
• Common causes include
• infection with Helicobacter pylori
• use of nonsteroidal anti-inflammatory drugs
(NSAIDs).
• Less common causes include
• Alcohol
• Smoking
• severe illness
• autoimmune problems
• radiation therapy
• Crohn's disease.

10. Gastritis
• Antacids are a common treatment for mild to medium gastritis
• When antacids do not provide enough relief
• H2 blockers
• proton-pump inhibitors
• Cytoprotective agents  protect the tissues that line of
stomach and small intestine.
• Sucralfate
• misoprostol

11. Peptic ulcer disease (PUD)
• break in the inner lining of the stomach
• the first part of the small intestine
• sometimes the lower esophagus.
• gastric ulcer - ulcer in the stomach
• Diagnosis
• Stomach pain is usually the first signal of a peptic
ulcer.
• Endoscopy

12. Peptic ulcer disease (PUD)
• Symptoms
• abdominal pain
• epigastric, mealtimes
• Duodenal ulcers,  three hours after taking a meal and wakes the
person from sleep
• bloating and abdominal fullness
• waterbrash
• nausea and copious vomiting;
• loss of appetite
• weight loss gastric ulcer;
• weight gain duodenal ulcer

13. Peptic ulcer disease (PUD)
• Symptoms
• hematemesis (vomiting of blood);
• directly from a gastric ulcer or from damage from severe/continuing
vomiting.
• melena (tarry, foul-smelling feces)
• due to presence of oxidized iron from hemoglobin
• Rarely- gastric or duodenal perforation
• which leads to acute peritonitis and extreme, stabbing pain and requires
immediate surgery..

14. Treatment
1. H. pylori - pantoprazole and clarithromycin are combined with either
amoxicillin or metronidazole
2. NSAIDs induced ulcers- NSAIDs are withdrawn with the introduction of
proton pump inhibitors
3. Bleeding- Intravenous PPIs
4. Endoscopic therapy - cautery, Endo clip, or epinephrine injection

15. Zollinger–Ellison syndrome
• tumors cause the stomach to produce too much acid, resulting in peptic ulcers
• Gastrinoma, a neuroendocrine tumor that secretes a hormone called gastrin
• overproduction of gastric acid by parietal cells
• commonly arise in the duodenum, pancreas or stomach
• Diagnosis
• Secretin stimulation test
• Gastrinoma cells release gastrin in response to secretin stimulation
• Fasting gastrin levels on at least three occasions
• Treatment
• Proton pump inhibitors
• H2-receptor antagonists
• Surgery to remove peptic ulcers or tumors might also be considered.

16. Thank You