DR. ARUN KUMAR ASSOCIATE PROFESSOR SANSKAR COLLEGE OF PHARMACY & RESEARCH, HAPUR (UP) INDIA

1. Peptic Ulcer

2. • Peptic ulcer disease (PUD) is a break in the lining
of 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 duodenal ulcer.
• The most common symptoms of a duodenal
ulcer are waking at night with upper abdominal
pain or upper abdominal pain that improves with
eating.
• With a gastric ulcer the pain may worsen with
eating. The pain is often described as a burning.

3. Symptoms
• Abdominal Pain. The pain is often described as
burning.
• Vomiting, weight loss, or poor appetite
• Complications may
include bleeding, perforation and blockage of the
stomach.
• Waterbrash (rush of saliva after an episode of
regurgitation to dilute the acid in esophagus.
• Nausea and copious vomiting
• A history of heartburn, gastroesophageal reflux
disease (GERD) and use of certain forms of
medication can raise the suspicion for peptic ulcer.

4. Complications:
• Gastrointestinal bleeding is the most common
complication. Sudden large bleeding can be life-
threatening.
• It occurs when the ulcer erodes one of the blood
vessels, such as the gastroduodenal artery.
• Perforation (a hole in the wall of the gastrointestinal
tract). Erosion of the gastro-intestinal wall by the
ulcer leads to spillage of the stomach or intestinal
content into the abdominal cavity.
• Penetration is a form of perforation in which the hole
leads to and the ulcer continues into adjacent organs
such as the liver and pancreas.

5. Causes
• H. pylori
• NSAIDs
• Stress
• Diet
• Gastric ischmeia

6. Pathogenesis of peptic disease
• There is a strong association between H.
pylori infection and gastroduodenal ulcers.
• H. pylori causes an inflammatory response in
gastric mucosa, with induction of epithelium
derived cytokines, predominantly interleukin (IL) 8
and IL 1β.
• Influx of neutrophils and macrophages into the
gastric mucosa with release of lysosomal
enzymes, leukotrienes (LT), hampers mucosal
defense and stimulates the process of ulcer
formation.

7. Diagnosis
• Abdominal Pain
• Ultrasound
• EGD (Endoscopy and Gastroscopy)
• Rapid urease test
• Stool antigen test

8. Treatment
• Proton pump inhibitors (PPIs) work by reducing
the amount of acid your stomach produces,
preventing further damage to the ulcer as it
heals naturally. They're usually prescribed for 4
to 8 weeks.
• Omeprazole, pantoprazole and lansoprazole are
the PPIs most commonly used to treat stomach
ulcers.
• Histamine (H2) receptor antagonists such as
Ranitidine, Famotidine, Cimatidine for duodenal
ulcers.

9. • PREVENTION
You may find relief from the pain of a stomach
ulcer if you:
• Choose a healthy diet.
• Consider foods containing probiotics.
• Consider switching pain relievers.
• Control stress.
• Don't smoke.
• Limit or avoid alcohol.
• Try to get enough sleep.