Peptic Ulcer Disease

R.Rajesh

Definition
Peptic ulcer disease (PUD) refers to a group of

ulcerative disorders of the upper gastrointestinal

(GI) tract that require acid and pepsin for their
formation.
Ulcer differs from superficial mucosal erosions in
that they extend deeper into the muscularis
mucosa.

Symptoms and Signs

Mild epigastric pain or acute life-threatening upper

gastrointestinal complications.

Abdominal pain, abdominal fullness, or cramping

Nocturnal pain that awakens the patient from sleep.
Heartburn, belching, and bloating.
Nausea, vomiting, and anorexia, weight loss
Complications, including ulcer bleeding, perforation,

penetration or obstruction.

Laboratory tests

Tests for Helicobacter pylori

The diagnosis of HP infection can be made using
Endoscopic or non endoscopic tests

Mechanisms
(Helicobacter Pylori) H. pylori is a Gram-negative,

spiral-shaped bacterium.
Most common cause of NSAIDassociated peptic
ulcer disease. H. pylori has been found in the
gastric antrum.
Eradication of H. pylori leads to lower recurrence
and relapse of ulcers.
H. pylori live in the acidic environment of the
stomach, transmitted by the oral route.

Patients with peptic ulcer disease should reduce

psychological stress, cigarette smoking, and non

steroidal anti inflammatory drug (NSAID) use,
and should avoid foods and beverages that
exacerbate ulcer symptoms.
Patients should be encouraged to eat balanced
meals at regular intervals.
There is no justification for bland or restrictive
diets. Moderate alcohol intake is not harmful.
Smoking retards the rate of ulcer healing and
increases the frequency of recurrences and
should be discouraged.

Pharmacologic Agents

Acid-Anti secretory Agents

Proton pump inhibitors

H2-receptor antagonists
Agents Enhancing Mucosal Defenses
H pylori Eradication Therapy

An antisecretory agent must be administered for

an additional 24 weeks (duodenal ulcer) or 46

weeks (gastric ulcer) after completion of the
antibiotic regimen to ensure complete ulcer
healing.

A once-daily oral proton pump inhibitor

(omeprazole or rabeprazole 20 mg, lansoprazole

30 mg, pantoprazole or esomeprazole 40 mg) is
most convenient.

Prostaglandins
Prostaglandins can be used in the treatment of

peptic ulcer disease specifically in the treatment

of NSAID-induced ulcers.

NSAIDs are ulcerogenic because they inhibit

prostaglandin synthesis and thereby interrupt the

gastroprotective functions of PGE2, which
include reduced gastric acid secretion and
enhanced bicarbonate secretion, mucus
production, and blood flow.

Misoprostol is a prostaglandin analogue used to

prevent NSAID-induced peptic ulcers.

Adverse effects: abdominal discomfort and
diarrhea interfere with patient compliance.
Misoprostol is contraindicated in pregnant women
because of the possibility of generating uterine
contractions that could result in abortion.

Modify Risk Factors

Diet, Tobacco, and Alcohol

To avoid caffeine-containing products because of

their ability to increase acid secretion.

Avoidance of alcohol and cigarette smoking.
Excessive alcohol intake is directly toxic to the
mucosa, and is associated with erosive gastritis
and an increased incidence of peptic ulcers.
Cigarette smoking is thought to decrease the
production of duodenal bicarbonate and diminish
mucosal blood flow, leading to a delay in ulcer
healing

Diseases Associated With Peptic Ulcers

Endocrine neoplasia
Chronic pulmonary diseases
Chronic renal failure
Kidney stones
Hepatic cirrhosis
1-antitrypsin deficiency.
Cystic fibrosis,
Chronic pancreatitis, Crohns disease,
Coronary artery disease, Polycythemia vera,
Hyperparathyroidism.

THANK U