Peptic Ulcer

Sarang Suresh

Hotchandani

It is a medical condition characterized by Ulcers

in;

Lower esophagus

Stomach

Duodenum

Jejunum

Ileum (adjacent to Meckel's Diverticulum)

INTRODUCTION

SARANG SURESH HOTCHANDANI

Ulcer is breach in

mucosal lining.

WHAT IS ULCER???


H. Pylori Infection

Stress Injury of mucus

secreting cell

ETIOLOGY OF PEPTIC ULCER


Chronic Use of

NSAIDs

Smoking Alcohol & Diet

ETIOLOGY OF PEPTIC ULCER


Gastric Ulcer

Chronic gastric ulcer is usually single.

Approx. 90% are situated in lesser curvature with the antrum or junction between

body and antral mucosa.

Duodenal Ulcer

Chronic duodenal ulcers occurs in 1st part of duodenum.

Approx. 50% are on anterior wall.

Gastric & duodenal ulcers co – exists in approx. 10% of patients.

Multiple peptic ulcers are found in approx. 10 – 15 % of patients.

EPIDEMIOLOGY


Approx. 90% of cases of duodenal ulcers patients & approx.

70% of gastric ulcer patients are infected with H. Pylori.

Others are by NSAIDs.

Infection is acquired in childhood from person to person

contact.

Majority of people infected with H. Pylori are asymptomatic &

healthy.

Only small number of people develop symptoms.

PATHOPHYSIOLOGY


H. Pylori

Depletion of antral D Cell Somatostatin

Increased gastric release from G cells

Increased Acid Secretion

Inflammation & UlcersSARANG SURESH HOTCHANDANI

H. Pylori only grow on gastric

type of mucosa.

Virulence Factors of H. Pylori;

Vacoulating cytotoxin A )Vac A)

Cytotoxin associated gene (Cag A)

Adhesion (BabA)

OiPA (Outer inflammatory protein A)

It is gram –ve, motile & spiral

bacteria

Uses adhesion molecule (BabA)

to bind Lewis B antigen on

epithelial cells.

Prevent its damage from acid

by producing urease which

convert ammonia into urea with

protects H. Pylori.

PROPERTIES OF H. PYLORI


Increase acid release from

stomach cause metaplasia of

duodenal mucosa which provide

environment for growth of H.

Pylori resulting duodenal ulcer.

H. PYLORI ONLY GROWS ON GASTRIC MUCOSA!

THEN HOW IT GROW IN DUODENUM RESULTING

DUODENAL ULCER


It is a chronic condition with spontaneous relapse & remissions.

The diagnostic value of individual symptoms for peptic ulcer is poor.

Most Common Presentation

Recurrent abdominal pain

Pain is epigastrium

relationship to food

Episodic occurrence

Vomiting in approx. 40% of patients.

CLINICAL FEATURES OF PEPTIC ULCERS


Anorexia & nausea.

Gastric ulcer pain increases with food.

Duodenal ulcer pain is relieved with

food.

CLINICAL FEATURES OF PEPTIC ULCERS


H. Pylori infection test.

Non – Invasive Serology

Urea Breath Test (High Specificity

& Sensitivity)

Fecal antigen test

Invasive Histopathology exam

Rapid urease test

Microbial culture

INVESTIGATIONS


Maintainace

Treatment

Surgical

Treatment.

H. Pylori

Eradication

General

Measures

MANAGEMENT OF PEPTIC ULCER


Proton Pump

Inhibitor

2 Antibiotics

• Amoxicillin

• Clarithromycin

• Metronidazole

H. PYLORI ERADICATION

7 DaysSARANG SURESH HOTCHANDANI

Proton Pump

Inhibitor

Bismuth Substrate

Metronidazole Tetracycline

H. PYLORI ERADICATION “OR”

10 – 14 DaysSARANG SURESH HOTCHANDANI

Diarrhea; approx. 30 – 50% of patients.

Flushing & vomiting when taken with alcohol.

Nausea & vomiting.

Cramps, headache, rashes.

SIDE EFFECTS OF H. PYLORI ERADIATION

THERAPY


Chronic proton pump

inhibitor user.

Idiopathic Thrombocyte

Purpura

Iron deficiency anemia

Peptic ulcer

Family history of Gastric

ulcer.

Previous resection of

gastric cancer.

H. Pylori Positive

INDICATIONS OF H. PYLORI ERADICATION

THERAPY


Gastro Esophageal Reflux

Disease

Asymptomatic Persons

CONTRAINDICATION OF H. PYLORI ERADICATION

THERAPY


AVOID

Smoking

Chronic NSAIDs

Alcohol

GENERAL MEASURES


Low dose of Proton

Pump Inhibitors

MAINTAINACE THERAPY


Operation of choice for

chronic non – healing

gastric ulcers is

Partial Gastrectomy.

SURGICAL TREATMENT


Elective

Gastric outflow

obstruction

Persistent

ulceration

Recurrent ulcer

Emergency

Perforation

Hemorrhage

INDICATIONS OF SURGICAL TREATMENT OF

PEPTIC ULCER


Iron deficiency anemia

Metabolic bone disease

Gastric cancer.

Dumpling

Bile reflux gastropathy

Diarrhea & mal digestion

Weight loss

COMPLICATION OF GASTRIC RESECTION


Zollinger – Ellison

Syndrome

It is triad of Peptic Ulcer +

Hyperchlorhydra + Non B

Cell tumor of Pancreas

Perforation

Peritonitis

Gastric outlet

obstruction

Bleeding

COMPLICATIONS PEPTIC ULCER


Sarang

Suresh

Hotchandani

Final Year

Dentistry

Student

Bibi Aseefa

Dental

College,

SMBBMU,

Larkana,

Sindh,

P A K I S T A N

THE END


Education

Peptic Ulcer