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Peptic ulcer disease

( PUD )

Dr. Randula Samarasinghe

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Peptic ulcer disease ( PUD )

PUD encompasses both gastric and duodenalulcers

Defnition o an ulcer

- disruption o the mucosal integrity o thestomach or duodenum leading to a local deector excaation due to actie in!ammation

Ulcers are oten chronic and benign

"ommon disorder #alignant ulcer is the main endoscopic

deerential diagnosis

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"auses o PUD

$elicobacter Pylori inection

%on steroidal anti in!ammatorydrugs

&ther

- cigarette smo'ing

- enetic predisposition - "hronic disease

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astric ulcer ( U )

&ccur later in lie ( sixth decade )

#ay be benign or malignant

enign * oten in the distal stomach (antrum )

$. Pylori and %S+,D induced inuryaccount or the maority o DU andU

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Duodenal ulcer ( DU )

end to occur earlier in lie /hencompared to U

Reduced incidence seen in /esternpopulation due to $. Pylorieradication treatment

01 2 seen in 3stpart o duodenum

4ast maority o DU are benign

#alignant duodenal ulcer extremelyrare

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$elicobacter Pylori

ram negatie spiral shaped bacterium

&nce person is inected the organism isound bet/een the gastric epithelium and

the mucous gel layer Produces urease /hich conerts urea to

amonium and ma'es the surrounding areaal'aline

$. Pylori inection is al/ays associated /ithchronic actie gasritis.

&nly 35 2 to 31 2 deelop ulcer

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Spread * person to person

67eaco-oral8 oro-oral

"hronic inection by $. Pylori can result in

- gastritis

- peptic ulcer disease

- gasrtic lymphoma

- gastric carcinoma subse9uent tointestinal metaplasia

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Detection o $. Pylori

,nasie testing

- Rapid urease test

- $istology - "ulture

%on inasie testing

- serology - urea breath test

- stool antigen

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"linical eatures o PUD

:pigastric pain

35 2 o patients /ith %S+,D inducedulcer present /ith a complication oPUD /ithout preceding symptoms opain

%ausea

;eight loss in U

&n examination epigastrictenderness is oten present

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"omplications o PUD

astrointestinal bleeding

Peroration

astric outlet obstruction

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,nestigations

Diagnosis o PUD

- arium study

- :ndoscopy * most sensitie andspecifc

procedure

,mportant to distinguish malignantrom benign U and perorming agastic biopsy is useul or thisur ose

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reatment

reatment o PUD may be medical orsurgical

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reatment ( medical )

+cid neutrali

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$. Pylori eradicationtreatment

Single drug therapy not e>ectie

#ulti drug regimes are used /hichcontains arious combinations o acidinhibitory drugs and antimicrobialdrugs

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Surgical treatment usually or ulcers/hich are reractory to medicaltreatment

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astritis

Gastritisis an in!ammation o thelining o the stomach

,t is a histological diagnosis

,t is not an endoscopic diagnosisunli'e PUD

he reason or this is because thecorrelation bet/een the histologicfndings o gastritis@ the symptomsand the endoscopic fndings is poor

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"auses o gastritis

+cute causes * alcohol@ %S+,DS@ollo/ing surgery@ burns

"hronic causes * $.pylori@autoimmune diseases@ chronic bilere!ux

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"linical eatures

+bdominal pain.

,ndigestion

elching

+bdominal bloating

%ausea and omiting

Pernicious anaemia

7ullness or burning in the upper abdomen "hronic gastritis usuually asymptommatic

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Diagnosis

&ten@ a diagnosis can be made based on thepatientAs description o his or her symptoms@but other methods /hich may be used toeriy gastritis includeB

lood testsBlood cell countPresence o H. pyloriCier@ 'idney@ gallbladder@ or pancreasunctions

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UrinalysisStool sample@ to loo' or blood in

the stool-rays:"s:ndoscopy@ to chec' or stomach

lining in!ammation and mucouserosion

Stomach biopsy@ to test or gastritisandother conditions

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#anagement

+ntacids

Proton pump inhibitors

reatment o the underlying condition eg-eradication o $. pylori

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han' you