20/05/2024
PEPTIC ULCER DISEASE
These are ulcers affecting areas of mucosa(inner layers) exposed to acidic gastric contents.The areas may include oesophagus, stomach or duodenum
It is associated with Helicobacter pylori(H.pylori)
Symptoms & Causes of Peptic Ulcers (Stomach Ulcers)
>A dull or burning pain in your stomach is the common symptom
>happens when your stomach is empty or soon after eating—such as between meals or during the night
>stops briefly if you eat or if you take antacids
>lasts for minutes to hours
>comes and goes for several days, weeks, or months
This occurs when there is an imbalance in the aggressive activity of acid-pepsin and the defensive mechanisms that resist mucosal digestion.
Amou all the categories of pelpitic ulcer, Duodenal ulcers are 4 times common than gastric ulcers
Peptic Ulcers can be broadly classified into:
1.Gastric ulcer (body and fundus)Peak age of incidence 50 yearsAssociated with H.pylori in 45% of cases and with high alcohol intake, smoking and NSAIDS
2.Duodenal ulcer (prepyloric)Peak age of incidence 25-30 yearsAssociated with H.pylori in 85% of cases , smoking and NSAID and use (NSAIDS include Ibuprofen, Asprin, diclofenac e.t.c)
3.Oesophagel ulcer
MANAGEMENT OF PUD
Life style modification;
>reduce alcohol intake
>Stop smoking
>Avoid NSAIDS
>cardiac/BPDrugs e.g Calcium Channel antagonists (nifedipine and nitrates)
Medical treatment include
>H2 blockers- Ranitidine 150mg po od , cimetidine 40mg po bd orProton Pump Inhibitors (PPI) – omeprazole 20mg po bd
>Ant- acids eg Bismuth
****H.pylori eradication therapy ( usually triple therapy of metronidazole, PPI and clarithromycin or amoxicillin 1g po bd)****
In Malawi 74% of H.pylori(the causecutive organism of PUD) have shown Metronidazole Resistance So a Longer treatment is prefered to The short course i.e
>Metronidazole 500mg two times daily for 14 days
>amoxicillin 1g twice daily for 2 weeks or clarithromycin
>omeprazole 20mg twice daily for 14 days
If left untreated pelpitic ulcer can complicate to;
>Acute upper GI bleeding
>Perforation of theviscera e.g stomach, intestines
>Anaemiadue to breeding
>Gastric outlet obstruction due to chronic scarring
You can ask about surgical managemant or more on this page Trema Jk 265
