Peptic ulcers form in the lining of the stomach, esophagus, or small intestine. Around 80% of ulcers are caused by Helicobacter pylori bacteria. Symptoms include abdominal pain, nausea, and vomiting of blood. Diagnosis involves tests to detect H. pylori infection and endoscopy to view the ulcers. Treatment focuses on eliminating H. pylori with antibiotics and reducing acid with proton pump inhibitors or H2 blockers to promote healing. Lifestyle changes and medications that protect the stomach lining can also help treat peptic ulcers.

3. Peptic ulcer
Presented by : Nooral Rafique Turbat Kech

5. Peptic ulcer:
Def:
 erosion in the lining (mucosa) of the digestive tract,
typically in 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
a duodenal ulcer.
 an ulcer in the esophagus is called Esophageal ulcer.

6.  Mucous layer
Coats and lines the stomach
First line of defense
 Bicarbonate
Neutralizes acid
 Prostaglandins
Hormone-like substances that keep blood vessels dilated for good blood flow
Thought to stimulate mucus and bicarbonate production
Stomach Defense Systems

9. Difference between gastric and
duodenal ulcer:
Gastric Ulcers: Pain occurs 1-2 hours after meals .
Pain usually does not wake patient.
Less common.
Usually occur in male as compared to female.
 Duodenal Ulcers: Pain occurs 2-4 hours after meals.
Pain wakes up patient.
More common.
Occur in male and female equally.
Hematemesis more.

10. Causes of ulcer.
 As many as 80% of ulcers are associated with Helicobacter pylori, a spiral-
shaped bacterium.
 ₪Ulcers can also be caused or worsened by drugs such as aspirin and
other NSAIDs.
 In addition, smoking and certain other genetic and environmental
factors (such as medications) may influence the course of peptic
ulcer disease.
 Psychological stress and dietary factors were once thought to be the
cause of ulcers.

11. Peptic ulcers are common and it has been estimated
that up to 10% of the population has as ulcer and
annual incidence of symptomatic peptic ulcer about
0.3%.

13. Properties of h. pylori:
 ¤ Gram-negative, slow-growing organism
 ¤ about 3 micrometers long with a diameter of about
 0.5 micrometers
 ¤has 4–6 flagella
 ¤ Helicobacter pylori is composed of a single circular chromosome with
1,667,867 base pairs, containing about 1590 coding regions
 ¤It is microaerophilic; that is, it requires oxygen, but at lower concentration
than is found in the atmosphere
 ¤It contains a hydrogenase which can be used to obtain energy by oxidizing
molecular hydrogen (H2) that is produced by intestinal bacteria.
¤

14. .
 .
NAME OF SCIENTISTSYEAR
1900s
1958
1982
Lykoudis
(general practitioner in Greece)
Barry Marshall & Robin
Warren
(Two Australian scientists)
WORK
First discovery of human
gastric bacteria
Treatment of patients for peptic
ulcer disease with
antibiotics
Helicobacter pylori was
rediscovered as a causative
factor for ulcers
1987 First study showing that
eradication of the organism
reduces duodenal ulcer
recurrence
1994
National Institutes of Health
convened a Consensus Panel
that issued guidelines for
management of ulcer cancer,
taking H. pylori into account
1996 The Food and Drug
Administration approves the
first antibiotic for treatment
of ulcer disease
1997 Centers for Disease Control
and Prevention
Launched a national education
campaign to inform health
care providers and consumers
about the link between H.
pylori and ulcers.

16. Symptoms of peptic ulcer:
 abdominal pain may occur and In case of duodenal ulcers the pain appears about
three hours after taking a meal.
 bloating and abdominal fullness;
 nausea and vomiting;
 weight loss;
 hematemesis (vomiting of blood); this can occur due to bleeding directly from a
gastric ulcer, or from damage to the esophagus from severe/continuing vomiting.
 Stomach pain wakes you up at night.
 An early sense of fullness with eating
 not wanting to eat because of pain.

18. DIAGNOSIS of peptic ulcer:
 Laboratory tests for H. pylori: Your doctor may recommend tests to
determine whether the bacterium H. pylori is present in your body. He
or she may look for H. pylori using a blood, stool or breath test. The
breath test is the most accurate. Blood tests are generally inaccurate
and should not be routinely used. For the breath test, you drink or eat
something containing radioactive carbon. H. pylori breaks down the
substance in your stomach. If you're infected with H. pylori, your
breath sample will contain the radioactive carbon in the form of
carbon dioxide.

19. Endoscopy.
 Your doctor may use a scope to examine your
upper digestive system (endoscopy). During
endoscopy, your doctor passes a hollow tube
equipped with a lens (endoscope) down your
throat and into your esophagus, stomach and
small intestine. Using the endoscope, your
doctor looks for ulcers.

21. Upper gastrointestinal series.
 Sometimes called a barium swallow, this series of
X-rays of your upper digestive system creates
images of your esophagus, stomach and small
intestine. During the X-ray, you swallow a white
liquid (containing barium) that coats your
digestive tract and makes an ulcer more visible.

23. Treatment of peptic ulcer:

26. Treatment of peptic ulcer:

for peptic ulcers depends on the cause. Usually
treatment will involve killing the H. pylori bacterium, if
present, eliminating or reducing use of aspirin and
similar pain medications, if possible, and helping your
ulcer to heal with medication.

27. Antibiotic medications to kill H. pylori.
 If H. pylori is found in your digestive tract,
your doctor may recommend antibiotics to
kill the bacterium. These may include
amoxicillin (Amoxil), clarithromycin
(Biaxin), metronidazole (Flagyl), tinidazole
(Tindamax), tetracycline (Tetracycline HCL)
and levofloxacin (Levaquin).

29. Medications that block acid production
and promote healing.
Proton pump inhibitors: the protein pump inhibitor bind to
the enzyme or protein pump and suppress the secretion of hydrogen ions
into the gastric lumen. These drugs include the prescription and over-
the-counter medication omeprazole (Prilosec), lansoprazole (Prevacid),
rabeprazole (Aciphex), esomeprazole (Nexium) and pantoprazole
(Protonix).
 Long-term use of proton pump inhibitors, particularly at high doses, may
increase your risk of hip, wrist and spine fracture. Ask your doctor
whether a calcium supplement may reduce this risk.

31. Medications to reduce acid production.
 (H-2) blockers = The histamine ,acetylcholine and gastrin are
responsible for production of HCL into the gastric lumen. These helps in
activation of protein kinases and helps to secrete hydrogen ions in
exchange for k into the lumen of the stomach. By blocking the histamine
causes reduce in secretion of HCL. reduce the amount of stomach acid
released into your digestive tract, which relieves ulcer pain and
encourages healing.
 Available by prescription or over-the-counter, acid blockers include the
medications ranitidine (Zantac), famotidine (Pepcid), cimetidine
(Tagamet HB) and nizatidine (Axid AR).

33. Antacid:
 These are weak bases that react with gastric acid to form
water and a salt to neutralize the gastric acidity.
 Commonly used antacid are aluminum hydroxide and
magnesium hydroxide .
 Antacids can provide symptom relief, but generally aren't used
to heal your ulcer.

35. Medications that protect the lining of
your stomach and small intestine:
 M.A.O: prostaglandin E produces by the gastric mucosa, which
inhibits the secretion of acid and stimulates secretion of mucus
and bicarbonate. The deficiency of prostaglandin is thought to
be involved in the pathogenesis of peptic ulcer.
 In some cases, your doctor may prescribe medications called
cytoprotective. These agents that help protect the tissues that
line your stomach and small intestine.
 Options include the prescription medications sucralfate
(Carafate) and misoprostol (Cytotec).

36. .