2. • An ulcer is an open sore . The word 'peptic' means that
the cause of the problem is acid. Peptic ulcers are sores
that develop in the lining of the stomach,lower
esophagus or small intestine. In other words Peptic Ulcer
disease is a condition in which painful sores or ulcers
develop in the lining of the stomach or the first part of
the small intestine (the duodenum). Normally, a thick
layer of mucus protects the stomach lining from the
effect of its digestive juices.But some etiological factors
reduce this protective layer,allowing stomach acid to
damage the tissue.
• It is a common health problem is formed as a result of
inflammation caused by the bacteria H.pylori as well as
from erosion from stomach acids and pepsin secretion.
3. • Generally , it is categorised into three parts-
• a. Gastric ulcer : ulcers inside the stomach
• b. Esaphageal ulcer : ulcers inside the esophagus
• c. Duodenum ulcer : ulcers in the upper part of small
intestine, i.e. duodenum
• Clinical Manifestations.
• Dull pain in the stomach
• Weight loss
• Not wanting to eat because of pain
• Nausea or vomiting
• Bloating
4. • Feeling easily full
• Burping or acid reflux
• Heartburn
• Indigestion
• Abdominal discomfort
• Anemia whose symptoms can include tiredness,
shortness of breath , or paler skin
• Dark , tarry stools
• Vomit that's bloody or looks like coffee grounds
5. • Complications of hemorrhage are observed in one third
of the patients.
• Etiology.
• Two main causes of ulcer are -
• Helicobacter pylori (H.pylori) bacteria-
• H.pylori commonly infect the stomach and it is
transmitted from person to person , especially during
childhood. The H.pylori bacteria stick to the layer of
mucus in the digestive tract and cause inflammation
(irritation) which can cause this protective linining to
break down .This breakdown is a problem because your
stomach contains strong acid intended to digest food .
Without the mucus layer to protect it , the acid can eat
into stomach tissue.
6. • Pain-releiving NSAID medications.
• Another major cause of peptic ulcer disease is the
use of NSAIDs, a group of medications used to
releive pain . NSAIDS can wear away at the mucus
layer in the digestive tract . For example aspirin ,
naproxen , ibuprofen . Use of corticosteroids (drugs
prescribed for asthma , arthritis or lupus) at the
same time as taking NSAIDs can precipitate ulcers.
7. • Rare causes :
• These inlude-
• Being seriously ill form from various infections or
disease.
• Having surgery.
• Taking other medications , such as steroids.
• Peptic ulcer disease can also occur if you have a rare
condition called Zollinger-Ellison Syndrome
(gastrinoma) . This forms a tumor of acid-producing
cells in the digestive tract. These tumours can be
cancerous or noncancerous . The cells produce produce
excessive amounts of acid that damages stomach
tissue.
8. • Pathophysiology.
• The primary cause of peptic ulcer is the imbalance
beween aggressive factors and defensive factors.
• Aggressive factors include Helicobacter pylori,
NSAIDs, pepsins , bile acids , smoking and alcohol.
• Defensive factors include bicarbonate , mucus layer
, prostaglandins , mucosal blood flow and epithelial
renewal.
• Disturbances in the above factors resulting in
mucosal damage which causes erosions and
ulcerations.
9. Pharmacological Treatment.
• The medication used for the treatment of peptic
ulcer is called as anti-ulcer drugs.
• Antiulcer agents can be classified as-
• H2 Antihistamines -
• H2 Acid blockers, also called histamine (H-2)
blockers reduce the amount of stomach acid
released into the digestive tract , which releives
ulcer pain and encourages healing. For example ,
Cimetidine , ranitidine , famotidine , roxatidine.
10. • Anticholinergic : Anticholinergic drugs reduce
gastric acid secretion and have been used in the
treatment of peptic ulcer, but their use is limited by
unwanted effects - dry mouth , blurred vision ,
constipation , difficulty in micturition in men and
excerbation of glaucoma. For example Pirenzepine ,
propantheline , oxyphenonium.
• Proton Pump Inhibitors.
• Proton pump inhibitors also called PPI reduce
stomach acid by blocking the action of the parts of
cells that produce acid. These drugs include the
prescription and over the counter medications
11. • Prostaglandin analogue :
• PGE2 and PGI2 are produced in gastric mucosa and
appear to serve as a protective role by inhibiting
acid secretion and promoting mucus and
bicarbonate secretion, thus has a cytoprotective
action.Prostaglandin also inhibit gastrin production
and increase mucosal blood flow. E.g. Misoprostol.
12. • Gastric acid neutralizers (Antacids) :
• Antacids neutralize exist stomach acid and can
provide rapid pain relief. Side effects can include
constipation or diarrhoea, depending on the main
ingredients . Antacids can provide symptom releif
but generally cannot heat the ulcer.
• Systemic Antacids : Sodium bicarbonate , Sodium
citrate
• Non systemic antacids : Magnesium hydroxide ,
Magnesium trisilicate , Aluminium hydroxide,
Calcium carbonate , Magaldrate.
13. • Ulcer Protective :
• These drugs cover the ulcer in a protective layer to
prevent further damage from digestive acids, For
example Sucralfate , Colloidal Bismuth , Subcitrate
(CBS).
• Anti H.pylori drugs :
• If H.pylori found in the digestive tract , doctors
recommend a combination of antibiotics to kill the
bacterium. These may include amoxicillin ,
clarithromycin , metronidazole, tinidazole ,
tetracycline and levofloxacin.
14. • Along with medications several lifestyle modifications and
habits resulting in suppressing the ulcer or its condition
should be incorporated.
• Don't mix alcohol with such as aspirin and NSAIDs should
be avoided.
• Avoid foods and beverages that dyspepsia or excerbate
ulcer symptoms i.e. spicy foods , caffeine , alcohol.
• Washing your hands frequently to avoid infections.
• Quit smoking and use of tobacco should be stopped.
• Maintaining a healthy lifestyle and eating a balanced diet
rich in fruits , vegetables and whole grains will help you
prevent developing a peptic ulcer.
15. • Lifestyle Modification : Along with medications
several lifestyle modifications and habits resulting
in suppressing the ulcer or its condition should be
incor
