Peptic ulcer disease is characterized by sores or breaks in the lining of the gastrointestinal tract, usually occurring in the stomach (gastric ulcer) or duodenum (duodenal ulcer). Risk factors include smoking, alcohol use, steroid use, older age, COPD, stress, and H. pylori infection. Treatment involves eliminating risk factors, antacids, H2 receptor antagonists, proton pump inhibitors, antibiotics for H. pylori infection, cytoprotective agents, and bismuth compounds. H. pylori infection is typically treated with combinations of proton pump inhibitors, clarithromycin or metronidazole, and amoxicillin or metronidazole

1. Peptic Ulcer Disease
HAMMAD KC
PHARM D

2.  Peptic : stomach Ulcer : sore or break in membrane
 It is the group of disorder characterised by presence of ulcer in any path of GIT
.Exposed to acid for sufficient duration and concentration.
 Having one or more sore in stomach (gastric ulcer ) or in duodenum (DU)

18. Also
Smocking
Alcohol
 Steroids
Age
 COPD
 Diarrhoea
 Stress

21. TREATMENT
 NON PHARMACOLOGICAL THERAPY
 Patients with PUD should eliminate or reduce psychological stress,
cigarette smoking, and the use of nonselective NSAIDs (including aspirin).
 No SPECIFIC “antiulcer diet,”
 the patient should avoid foods and beverages (e.g., spicy foods, caffeine,
and alcohol)
 alternative agents such as acetaminophen, nonacetylated salicylate
(e.g., salsalate) should be used for relief of pain.

22.  PHARMACOLOGICAL THERAPY
 1.Antibiotics
 For H.Pylori
 Ex. Amoxicillin 1g BID
Clarithromycin 500mg BID
 2.PPI
 Decreases gastric acid secretion by inhibiting H+/K+ ATPase pump
 Ex. Pantoprazole 40mg OD
Esmoprazole 20-40mg 4-8 days

23.  3. CYTOPROTTECTANTS
 These agents have ability to increase prostaglandin synthesis and thus it act as
cytoprotectants
 Ex : Misoprostol 200mg 4 times daily
Sucralfate (act by forming protective lining) 1g dialy 1-1-1-1
 4. H2 RECEPTOR ANTAGONIST
 They block H2 receptor on parital cell resulting in reduced acid secreation and
enhance ulcer healing
 Ex ; Cimetidine 400mg BID
Ranitidine 150 mg BID

24.  5.ANTACID
 Ex : Gelucil
 6.BISMUTH COMPOUNDS
 Ex. Colloidal bismuth subsalicyate 480mg / Day
 MOA : Increases glycoprotein secretion and act as diffusion barrier
 7.GASTROINTESTINAL ANTI CHOLINERGIC
 Decreases the gastric acid secretion and pepsin recreations
 Ex : Atropine , belladonna leaf

25. For H.pylori infection we use
 For H.pylori infection we use
 1.Proton pump inhibitor-based 3-drug regimens
 Drug #1 Omeprazole 20 mg twice daily
 or lansoprazole 30 mg twice daily or metronidazole 500 mg twice daily
 Drug #2
 Clarithromycin 500 mg twice daily
 Drug #3
 Amoxicillin 1 g twice daily OR metronidazole 500 mg twice daily

26.  2.Bismuth-based 4-drug regimens
 Drug #1
 Omeprazole 40 mg twice daily
 or lansoprazole 30 mg twice daily ETC..
 Drug #2 : Bismuth subsalicylate 525 mg four times daily
 Drug #3 : Metronidazole 250–500 mg four times daily
 Drug #4 : Tetracycline 500 mg four times daily
or amoxicillin 500 mg four times daily,
or clarithromycin 250–500 mg four timesdaily

27. THANK YOU