A short note on APD

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