Diseases

Peptic Ulcer : Causes, Pathogenesis, Symptoms, Diagnosis, Treatment & Prevention

Peptic Ulcer Disease (PUD) : Causes, Pathogenesis, Symptoms, Diagnosis, Treatment & Prevention

Definition :

  • Peptic ulcers are the areas of degeneration and necrosis of gastrointestinal mucosa exposed to acid-peptic secretions.
  • Though they can occur at any level of the alimentary tract that is exposed to hydrochloric acid and pepsin, they occur most commonly (98-99%) in either the duodenum (Duodenal ulcers) or the stomach ( Gastric ulcers) in the ratio of 4:1. Among duodenum & stomach, most common in the gastric antrum and first portion of the duodenum.
  • Peptic ulcer disease (PUD) /Peptic ulcers most often is associated with H. pylori infection or NSAID use.

Clinical symptoms :

  • Peptic ulcers are chronic, recurring lesions that occur most often in middle-aged to older adults without obvious precipitating conditions, other than chronic gastritis.
  • A majority of peptic ulcers come to clinical attention after patient complaints of epigastric burning or aching pain, although a significant fraction manifest with complications such as iron deficiency anemia, frank hemorrhage, or perforation. Nausea,vomiting, bloating, and belching may be present.
  • The pain tends to occur 1 to 3 hours after meals during the day, is worse at night, and is relieved by alkali or food.
  • Healing may occur with or without therapy, but the tendency to develop ulcers later remains.

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Types :

1.  Acute/Stress Peptic ulcer

  • Acute peptic ulcers are multiple, small mucosal erosions, seen most commonly in the stomach but occasionally involving the duodenum.
  • Etiology : Acute peptic ulcers ulcers occur following severe stress.
    –  Psychological stress
    –  Physiological stress as in Shock, Severe trauma, Septicaemia, Extensive burns (Curling ulcers in the proximal duodenum), Intracranial lesions ( Cushing ulcers ), Local irritants (e.g. Alcohol,smoking, coffee etc).
  • Pathogenesis : It is not clear how the mucosal erosions occur in stress ulcers because actual hypersecretion of gastric acid is demonstrable in only Cushing’s ulcers occurring from intracranial conditions such as due to brain trauma, intracranial surgery and brain tumours. In all other etiologic factors, gastric acid secretion is normal or below normal.

2. Chronic Peptic ulcer

Treatment :

Peptic ulcers can be treated by medications  in following way :

1. Reduction of gastric acid secretion

H2 antihistamines Proton pump inhibitors Anticholinergics Prostaglandin analogue
Cimetidine Omeprazole Pirenzepine Misoprostol
Ranitidine Pantoprazole Propantheline  
Famotidine Rabeprazole Oxyphenonium  
Roxatidine Lansoprazole    
Nizatidine Esomeprazole    
  Dexlansoprazole

2. Neutralization of gastric acid/Antacids

Systemic Nonsystemic
Sodium bicarbonate Magnesium hydroxide
Sodium citrate Calcium carbonate
Magnisium trisilicate
Aluminiumhydroxide
Magaldrate
Sodium Bicarbonate

3 . Mucosal protectives:

Mucosal protectives
Bismuth Subsalicylate
Sucralfate
Colloidal bismuth subcitrate (CBS)

4 . Anti-H.pylori drugs:

Anti-H.pylori drugs
Amoxicillin
Tinidazole
Metronidazole
Clarithromycin
Tetracycline

5. Anti-Muscarinic agents:
E.g. Dicyclomine

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