Peptic ulcer disease.

1. PEPTIC ULCER DISEASE
Dr. M SHEKHANI

2. Contents
1
DEFINITION
2
PATHOPHYSIOLOGY
3
AETIOLOGY
4
PREDISPOSING FACTORS

3. Contents
5
6
D.DIAGNOSIS
DIAGNOSTIC WORK-UP
7
MANAGEMENT
8
MEDICATIONS LIST

4. Definition:
•
Mucosal defect in the lower oesophagus, stomach or duodenum,
in the jejunum after surgical anastomosis to the stomach or,
rarely, in the ileum adjacent to a Meckel’s diverticulum..

5. Epidemiology:
• M/F for DU 5:1 - 2:1, GU 2:1 or less.
• Chronic gastric ulcer is usually single; 90% on the lesser
curve within the antrum or body-antral junctio.
• Chronic DU usually occurs in D1 just distal to the pyloric;
50% on anterior.
• GU/DU coexist in 10%
• > 1 PU is found in 10–15%.

6. Pathophysiology
H Pylori: in > 50% of gen population
HP
>90% DU
>70% GU
H Pylori
NSAIDs
Smoking
9O% DU,70% GU.
In DU infect D cells leading to
hypergastrinemia&hyperacidity.
30%;Impair mucosal defence
through inhibiting PGs.
Smoking
> Complication & < healing.
?Genetics
Rarely ZES
NSAIDs

7. Pathophysiology: How HP produces PUD.
Adhesins
(BabA)&(o
ipA)
Bacterial
factors:
vacA
cagA
•Smoking
Host genetic
polymorphisms:
•IL-1β
expression
NSAIDs use.

11. Clinical features:
40%
vomiting
In some
Asymptomatic present
with complications as GIB,
Perforation.
Daily vomiting? GOO
R/Rs
30% atypical
Elderly on NSAIDs:
unease;anorexia
Symptoms
Poor predictors of PUD
Presence.

12. Investigations:
Endoscopic biopsy:
1. For DU not needed
because mostly benign
except for HP diagnosis
or if giant or atypical
features( Crohns,TB,Ly
mphoma,cancer).
2. For GU needed BZ may
be malignant.
nd
E
py
co
os
HP test

20. ZES:Gastrinoma
90%: Pan head or
duodenum
50% multiple
½-2/3 malignant but
slow growing
20-60% part of
MEN1
Features:
Short history
Complicated more.
Ulcers> in unusual
sites, D2,Jej,eso.
Unresponsive to trt.
Recurs after surgery.
Diarrhea in 50%.
Diagnosis:
Diagnosis:
Serum gastrin
10-1000 fold
increase&
paradoxical inc
with secretin.
Localization by:
EUS& SST Rec
scintigraphy.

21. Drugs for PUD:
PPI/HSRAs/Antacids
Acid
suppresants:
Mucosal
resistance
enhancers
Both:
Sucralfate/Carbinoxolone.
Prpstaglandins.