peptic ulcer

PEPTIC ULCER
BY
ABHILASH.BATHINA

Contents- Introduction
Causes
Symptoms
Diagnosis
Treatment
Medication
Case studies
Conclusion
References
Acknowledgement

• Peptic Ulcer:
 An open sore on an external or internal
surface of the body
 It caused by a break in the skin or mucous
membrane which fails to heal
 Ulcers range from small, painful sores in
the mouth to bedsores and serious lesions
of the stomach or interstine
Gastric ulcers :are peptic ulcers in the
stomach.
Duodenal ulcers :are peptic ulcers in the
duodenum
Types of ulcers Fig.no-
Fig.no-
1
2

Causes-
1] Most ulcers are caused by an infection from bacteria. This
bacteria is called Helicobacter pylori. 90% of gastric ulcers
and 75% of duodenal ulcers are from Helicobacter
pylori infection.
2] Taking some drugs called NSAIDs (Non-Steroidal Anti-
Inflammatory Drug) – These are medicines used for pain
and inflammation, such as aspirin, ibuprofen, and naproxen.
3]Smoking cigarettes.
4]Age factors[Old age]
5]Stress from diseases or injuries like pneumonia and burns
6]Heridatory-If someone in a family has a duodenal ulcer.

Symptoms-
 A symptom is a change in the body that tells
someone that they have a disease. The biggest
symptom is pain in the stomach. Pain is
usually in the top of the abdomen below the
ribs. Some people also feel pain go up to the
chest.
 Other symptoms are:
 Vomiting
 Blood in vomit – this can be red. This can
also look like coffee grounds (the black
substance that is left after making coffee.)
 Black stools, e.t.c.,
Fig.no- 3

factors causing peptic ulcer:
Peptic ulcer caused due to high gastrin level and excess acid
production. Gastrinoma may cause multiple peptic ulceration as in
Zollinger Ellison syndrome. There is increased parietal cell mass.
 H. pylori infection is present in almost all patients with duodenal
ulcers and 70% cases with gastric ulcers.
Peptic ulcers caused due to impaired mucosal defense . The gastric
acid and pepsin levels are normal and no H.pylori are present.
 Chronic use of NSAIDs (aspirin) causes suppression of mucosal
prostaglandin and direct irritative topical effect.
 Repeated use of corticosteroid in high dose.
 Cigarette smoking impair healing and favour recurrences.
 Alcoholic cirrhosis.
 Personality, psychological stress, ischemia.

 H. pylori infection is present in almost all patients with
duodenal ulcers and 70% cases with gastric ulcers.
 Duodenal ulcers - Usually associated with gastritis
confined to the antrum.
 Gastric ulcers - Usually associated with pangastritis.
Role of H. Pylori infection in the pathogenesis of
peptic ulcer:
Fig.no- 4

Mechanism
H. pylori secretes urease (generates ammonia), protease (breaks
down glycoprotein in the gastric mucus) or phospholipases.
Bacterial lipopolysaccharide attracts inflammmatory cells to the
mucosa. Neutrophils release myeloperoxide.
A bacterial platelet-activating factor promotes thrombotic
occlusion of surface capillaries.
Mucosal damage allows leakage of tissue nutrients in the surface
microenvironment , sustaining the bacillus.

Damage of the protective mucosal layer. The epithelial cells are
exposed to the damaging effect of acid-peptic digestion.
Inflammation of the gastric mucosa.
Ulcers occur at sites of chronic inflammation .
Eg - Antrum
Contd…….

Diagnosis-
Diagnosing is how doctors see if someone
has a disease. They do this by running tests. Peptic
ulcers are diagnosed by three ways:
1)Endoscopy – looking inside someones stomach
with a camera that goes through their mouth and
down to their stomach
2)Test on the air someone breathes out to look
for Helicobacter pylori infection
3)Blood test to look for Helicobacter pylori infection Fig.no- 5

MEDICAL TREATMENT
• Eradication of H.pylori (proton pump inhibitor in combination with
antibiotics)
• Acid suppression- Antacid & or H2 blockers
• Cessation of NSAIDS.
Criteria for reduction of the size of ulcer crater.
Reduction of crater size by 50% over 6-8 weeks of intensive medical
management.
SURGICAL TREATMENT
•Subtotal gastric resection without vagotomy
and drainage (gastroenterostomy or pyloroplasty)
•Truncal vagotomy plus antrectomy
TREATMENT
Fig.no-
Fig.no-
6
7

PPI (H2-RA)
or
Bismuth
Two
Antibiotics+
Clarithromycin 250-500mg
Amoxicillin 500-1000mg
(Tetracycline)
Metronidazole 400mg
Furazolidone 100mg
Colloidal Bismuth
Subcitrate ( CBS)
240mg
Triple therapy, bid for 1 week
Eradicate H.Pylori Infection

Colloidal Bismuth
Subcitrate ( CBS)
Clarithromycin
Amoxicillin
PPI (H2-RA)
Eradication H.Pylori Infection

Metronidazole
Furazolidone
This are the drugs used to Eradicate H.Pylori Infection
Eradication H.Pylori Infection

Inhibit acid secretion
 H2-Receptor Antagonists
 Cimetidine 400mg bid
 Ranitidine 150mg bid
 Famotidine 20mg bid
 Proton Pump Inhibitors
 Omeprazole 20mg qd
 Lansoprazole 30mg qd
 Pantoprazole 40mg qd
 Rabeprazole 10mg qd
 Esomeprazole 20mg qd
DU：
4 - 6 wks
GU：
6 - 8 wks
MEDICAL TREATMENT

H2-Receptor Antagonists
Ranitidine
Cimetidine Famotidine

Proton Pump Inhibitors
Omeprazole Lansoprazole Pantoprazole
Rabeprazole Esomeprazole

Surgery:-
•People who do not respond to medication, or
who develop complications:
1)Vagotomy - cutting the vagus nerve to
interrupt messages sent from the brain to the
stomach to reducing acid secretion.
2)Antrectomy - remove the lower part of the
stomach (antrum), which produces a hormone
that stimulates the stomach to secrete
digestive juices. A vagotomy is usually done
in conjunction with an antrectomy.
8
9
Fig.no-
Fig.no-

3)Pyloroplasty - the opening into the duodenum and small
intestine (pylorus) are enlarged, enabling contents to pass more
freely from the stomach. May be performed along with a
vagotomy.
Surgery:-
10Fig.no-

Establish the diagnosis
(endoscopy or UGI)
Gastric ulcer
biopsy, R/O cancer
Duodenal ulcer
Assess pathogenesis:
H.pylori
NSAIDs
Smoking
Family history
Serum gastrin
Therapy:
Treat H.pylori
Acid suppression
Enhance mucosa defense
Document H.pylori eradication
Complications -Surgery
(obstruction, perforation, intractable bleeding, malignant transformation)
Endoscopic follow-up
to healing

Choose a healthy diet-Choose a
healthy diet full of fruits, vegetables
and whole grains. Not eating vitamin-
rich foods may make it difficult for
your body to heal your ulcer.
Consider switching pain
relievers- If you use pain relievers
regularly, ask your doctor whether
acetaminophen (Tylenol, others)
may be an option for you.
Lifestyle and home remedies
You may find relief from the pain of a stomach ulcer if you:

Don't smoke-Smoking may
interfere with the protective lining
of the stomach, making your
stomach more susceptible to the
development of an ulcer. Smoking
also increases stomach acid.
Limit or avoid alcohol- Excessive
use of alcohol can irritate and erode
the mucous lining in your stomach
and intestines, causing
inflammation and bleeding

Control stress-Stress may worsen
the signs and symptoms of a
peptic ulcer. Examine your life to
determine the sources of your
stress and do what you can to
address those causes. Some stress
is unavoidable, but you can learn
to cope with stress with exercise,
spending time with friends or
writing in a journal.

peptic ulcer

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