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Peptic Ulcer Disease (PUD) : Dr. Goytiom Y (MD)

Peptic ulcer disease results from an imbalance between defensive and aggressive factors in the stomach and duodenum. Common risk factors include Helicobacter pylori infection, NSAIDs, and smoking. Patients typically present with epigastric pain relieved by food or antacids. Treatment involves stopping smoking, PPIs for a few weeks, and H. pylori eradication therapy to reduce high relapse rates of uncomplicated ulcers. Surgical intervention is needed for complications like perforation, obstruction, or bleeding.

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Latii Leta
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40 views15 pages

Peptic Ulcer Disease (PUD) : Dr. Goytiom Y (MD)

Peptic ulcer disease results from an imbalance between defensive and aggressive factors in the stomach and duodenum. Common risk factors include Helicobacter pylori infection, NSAIDs, and smoking. Patients typically present with epigastric pain relieved by food or antacids. Treatment involves stopping smoking, PPIs for a few weeks, and H. pylori eradication therapy to reduce high relapse rates of uncomplicated ulcers. Surgical intervention is needed for complications like perforation, obstruction, or bleeding.

Uploaded by

Latii Leta
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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Peptic Ulcer Disease (PUD)

Dr. Goytiom Y (MD)


Anatomy
Cont…
Peptic ulcer diseases

• It is a break in the mucosal surface, bigger than


5mm in size with depth to sub- mucosa.
• Ulcers occur most commonly in the stomach
(GU) and proximal duodenum (DU)
Types of gastric Ulcer
Cont…
• The most important risk factors are:-
 Helicobacter pylori infection
 Non-steroidal anti inflammatory drugs
 Cigarette smoking
Conti..
• Pathophysiology of Ulcer Diseases
 Peptic ulcers develop as a result of an imbalance
between defensive factors and aggressive factors
• Defensive factors include
 Prostaglandins,
 Mucus
 Bicarbonates
 Mucosal blood flow
Conti…
• Aggressive factors
 Pepsin
 Hydrochloric acid.
Clinical presentations
• Generally PUD patient present with onset
epigastric Pain, burning, bloating , abdominal
fullness, nausea and vomiting
Conti…

Duodenal ulcer
• Pain is relieved by food or antacids
• recurs 2–4 hours after eating
• Weight loss not common
• Melena is common
Gastric ulcer
• Pain aggravated by ingestion of food
• Hematemisis common
Cont….
• The pain comes within 30 minutes of ingestion
of food
• Nausea and vomiting common
• Weight loss common because of fear to eat
Comparison of DU& GU
criteria Doudenal ulcer Gastric ulcer
1 . Age Usually younger 10 yrs older than DU

2. Acid High Usually low to normal

3. Pain 2-3 hrs after meal & get relieved with Aggravate with eating
meal
4. Weight loss Less common Common

5. Risk of Uncommon 3-5%


malignancy
6. H.pylori >90% 60-90%

01/28/2024 11
Cont…

Investigations
• CBC
• H.pylori test
• serum amylase &lipase
• liver function test
• Stool occult test
• Abdominal Ultrasound
• Abdominal x-ray
• Endoscopy
PUD Complication
• Bleeding
• Perforation
• GOO
Conti

Treatment of PUD
A. Medical (for uncomplicated PUD)
-Stop smoking
-H2 receptor antagonist (high relapse rate)
-Proton pump inhibitors (Omeprazole 20mg
PO BID for 02 weeks-high relapse rate)
-Eradication therapy for all patients with PUD
(except NSAID) Omeprazole, Amoxicillin,
Metronidazole/Clarythromycine.
cont…

• Surgical treatment is indicated for:-


 Perforation
 Obstruction
 Bleeding

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