Peptic ulcer disease is a break in the lining of the stomach or small intestine that causes abdominal pain which can worsen or improve with eating. Common symptoms include burning abdominal pain, vomiting, weight loss, and poor appetite. Complications can include bleeding, perforation, or blockage. Causes of peptic ulcers include H. pylori infection, NSAID use, stress, diet, and gastric ischemia. Diagnosis involves abdominal exams, ultrasound, endoscopy, and tests for H. pylori. Treatment primarily uses proton pump inhibitors to reduce acid production and allow healing.

1. Peptic Ulcer

2. • Peptic ulcer disease (PUD) is a break in the lining
of the stomach, first part of the small intestine or
occasionally the lower esophagus.
• An ulcer in the stomach is known as a gastric
ulcer while that in the first part of the intestines
is known as duodenal ulcer.
• The most common symptoms of a duodenal
ulcer are waking at night with upper abdominal
pain or upper abdominal pain that improves with
eating.
• With a gastric ulcer the pain may worsen with
eating. The pain is often described as a burning.

3. Symptoms
• Abdominal Pain. The pain is often described as
burning.
• Vomiting, weight loss, or poor appetite
• Complications may
include bleeding, perforation and blockage of the
stomach.
• Waterbrash (rush of saliva after an episode of
regurgitation to dilute the acid in esophagus.
• Nausea and copious vomiting
• A history of heartburn, gastroesophageal reflux
disease (GERD) and use of certain forms of
medication can raise the suspicion for peptic ulcer.

4. Complications:
• Gastrointestinal bleeding is the most common
complication. Sudden large bleeding can be life-
threatening.
• It occurs when the ulcer erodes one of the blood
vessels, such as the gastroduodenal artery.
• Perforation (a hole in the wall of the gastrointestinal
tract). Erosion of the gastro-intestinal wall by the
ulcer leads to spillage of the stomach or intestinal
content into the abdominal cavity.
• Penetration is a form of perforation in which the hole
leads to and the ulcer continues into adjacent organs
such as the liver and pancreas.

5. Causes
• H. pylori
• NSAIDs
• Stress
• Diet
• Gastric ischmeia

6. Pathogenesis of peptic disease
• There is a strong association between H.
pylori infection and gastroduodenal ulcers.
• H. pylori causes an inflammatory response in
gastric mucosa, with induction of epithelium
derived cytokines, predominantly interleukin (IL) 8
and IL 1β.
• Influx of neutrophils and macrophages into the
gastric mucosa with release of lysosomal
enzymes, leukotrienes (LT), hampers mucosal
defense and stimulates the process of ulcer
formation.

7. Diagnosis
• Abdominal Pain
• Ultrasound
• EGD (Endoscopy and Gastroscopy)
• Rapid urease test
• Stool antigen test

8. Treatment
• Proton pump inhibitors (PPIs) work by reducing
the amount of acid your stomach produces,
preventing further damage to the ulcer as it
heals naturally. They're usually prescribed for 4
to 8 weeks.
• Omeprazole, pantoprazole and lansoprazole are
the PPIs most commonly used to treat stomach
ulcers.
• Histamine (H2) receptor antagonists such as
Ranitidine, Famotidine, Cimatidine for duodenal
ulcers.

9. • PREVENTION
You may find relief from the pain of a stomach
ulcer if you:
• Choose a healthy diet.
• Consider foods containing probiotics.
• Consider switching pain relievers.
• Control stress.
• Don't smoke.
• Limit or avoid alcohol.
• Try to get enough sleep.