Peptic Ulcer

1. PRESENTED BY :
DR DEEPTI DEWAN
PG Scholar
UNDER THE GUIDANCE OF : DR ANUPAMA
DEPARTMENT OF CASE TAKING & REPERTORY
GOVERNMENT HOMOEOPATHIC COLLEGE & HOSPITAL
BENGALURU, KARNATAKA

2. APD= Acid Peptic Disease
Peptic Ulcer
Gastric Ulcer
Duodenal Ulcer
Hyperacidity
ZE Syndrome
GERD

3. APD= Acid Peptic
Disease
Acute Ulcer
Stress Ulcer
Curling’s Ulcer
Cushing’s Ulcer

4. APD
Incidence
Aetiology
CP
Investigations
DD
Rx

5. Peptic Ulcer
Approximately one case per 1000
person-years in the general
population, and the incidence of
ulcer complications was
approximately 0.7 cases per 1000
person-years
Reference : Peptic ulcer disease: Epidemiology, etiology, and pathogenesis. Available at :
https://www.uptodate.com/contents/peptic-ulcer-disease-epidemiology-etiology-and-
pathogenesis#PATIENT_INFORMATION

7. Duodenal Ulcer
Proximal duodenum
1 - 2 cm of pylorus
▲ acid
Distal duodenum = Zollinger–
Ellison syndrome

8. Type 1 Gastric Ulcer
most common (among gastric
Ulcers)
proximal antrum
 mucosal defense
 acid

9. Type II Gastric Ulcer
Secondary to DU + pyloric
stenosis

10. Type III Gastric Ulcer
Prepyloric and pyloric canal ulcer
acid ▲
common etiology with DU

11. APD
Incidence
Aetiology
CP
Investigations
DD
Rx

12. Hurry
Worry
Curry

13. Pathogenesis
Imbalance of acid-pepsin
and mucosal defence
H. pylori infection
NSAID
ZE Syndrome
Type A personality

14. H.pylori
95% - duodenal ulcer
80% - gastric ulcer
 mucosal resistance
hydrophobicity
eradication reduces ulcer
recurrence

15. NSAID
Suppress prostaglandins
prostaglandin ►
 acid secretion
 ▲ mucosal blood flow
 mucus & bicarbonate secretion
10 -30% in chronic users

16. ZE= Zollinger Ellison Syndrome
Recurrent
Recalcitrant
Resistant
Unusual sites
Multiple
Malignant

17. ZE Syndrome
0.1 - 1.0% of peptic ulcer
Type I and Type II
Gastrin secretion from non-beta cell
tumor of pancreas - Gastrinoma
MC in pancreas ; duodenum, antrum

18. ZE Syndrome
20% multiple
66% malignant
slow growing indolent tumor
parietal cell mass increased
genetic basis
massive hyper-secretion of acid

19. ZE Syndrome
MEN - I
– hyperparathyroidism
– islet cell tumor
– pituitary tumors

20. A/ DU
NSAIDs
Acid hypersecretion
Rapid gastric emptying
Impaired acid disposal
Smoking

21. Duodenal Ulcer
Increased secretion of acid
More rapid gastric emptying
Decreased prostaglandin
Chronic duodenitis with H.pylori
Smoking

22. Gastric Ulcer
H.pylori
NSAIDs
Duodenogastric reflux
Impaired gastric mucosal defense

23. Gastric Ulcer
Acid secretion - normal to low
Reflux of duodenal contents 
gastritis  ulcer
Pylorus sphincter disorder
Smoking
Disturbed mucosa with low grade
gastritis

24. APD
Incidence
Aetiology
CP
Investigations
DD
Rx

25. CP
Duodenal Ulcer
– pain relieved by food or alkali
– pain several hours after meal
Gastric Ulcer - gnawing or
burning pain on eating

26. Clinical Presentation
Periodic chronic recurrent pain
Nausea & vomiting
Weight loss
Epigastric tenderness

27. APD
Incidence
Aetiology
CP
Investigations
DD
Rx

28. Investigations
Endoscopy
– 90% sensitivity
– must in all pts. with severe pain
– excludes malignancy
– biopsy can be taken
– test for H.pylori

29. Investigations
Barium Meal double (air)
contrast
– 90% sensitivity

30. H Pylori detection:
Breath test
Blood test
Tissue test

31. APD
Incidence
Aetiology
CP
Investigations
DD
Rx

32. Differential Diagnosis
Cholecystitis
Hiatus hernia
Pancreatitis
MI
Pneumonia
Dissecting aneurysm
Worm Infestations

33. APD
Incidence
Aetiology
CP
Investigations
DD
Rx

36. Treatment
Stop smoking, NSAIDs
Stop alcohol
Antacids - acid neutralisation
H2 receptor antagonist -
Ranitidine- secretion inhibition

37. Rx- Medical
H+ pump inhibition - H+/K+ase
inhibition - Omeprazole
Anticholinergic - secretory
inhibition
Prostaglandin - Misoprostol
- mucosal protection

38. Hemorrhage
Hemorrhage - potential cause of
death
15 -20% gross bleeding
erosion of duodenal ulcer into
gastro-duodenal artery
Endoscopy –laser, sclerosant
oralcohal injection

39. Perforation
In 5-10% of cases
pneumo-peritoneum in 75% cases
peritonitis, pain, ileus
leukocytosis, hypovolumia, IIIrd
space loss
DD - acute appendicitis, enteric
perf.

40. Obstruction
Chronic ulcer disease with edema
and scarring
in 5% cases of DU
nausea, vomiting, abdominal
distension
metabolic alkalosis, paradoxical
aciduria

41. Obstruction
Endoscopy
Ba study
Scintigraphy

42. Homoeopathic Management
Acute Medicines – To Manage acute
episodic symptoms
Constitutional medicines can be
prescribed for cure

43. Repertory