Peptic Ulcer Disease and its Screening

Disruption of Gastric Mucosal Barrier
Two mechanisms that protect
• Mucus forms a layer that entraps or slows diffusion of hydrogen ions across mucosal barrier
• Bicarbonate is secreted
• Neutralizes HCl acid in lumen of GI tract
• Vagal nerve stimulation results in hypersecretion of HCl acid
• HCl acid can alter mucosal barrier
• Duodenal ulcers are associated with acid

Peptic Ulcer Disease Clinical Manifestations
• Common to have no pain or other symptoms
• Gastric and duodenal mucosa not rich in sensory pain fibers
• Duodenal ulcer pain
• Burning, cramplike
• Gastric ulcer pain
• Burning, gaseous
• 3 major complications
• Hemorrhage
• Perforation
• Gastric outlet obstruction

Peptic Ulcer DiseaseHemorrhage
• Most common complication of peptic ulcer disease
• Develops from erosion of
• Granulation tissue found at base of ulcer during healing
• Ulcer through a major blood vessel

• Occurs when ulcer penetrates serosal surface
• Spillage of their gastric or duodenal contents into peritoneal cavity
• Size of perforation directly proportional to length of time patient has had ulcer
• Sudden, dramatic onset

Peptic Ulcer Disease Gastric Outlet Obstruction
• Ulcers located in antrum and prepyloric and pyloric areas of stomach
• Duodenum can predispose to gastric outlet obstruction
• contractile force needed to empty stomach results in hypertrophy of stomach wall
• Peptic Ulcer DiseaseGastric Outlet Obstruction
• After longstanding obstruction stomach enters decompensated phase
• Results in dilation and atony
• Obstruction is not totally due to fibrous scar tissue
• Active ulcer formation is associated with edema, inflammation, pylorospasm
• All contribute to narrowing of pylorus
• Usually has a history of ulcer pain
• Short duration or absence of pain indicative of a malignant obstruction
• Vomiting is common
• Constipation is a common complaint
• Dehydration, lack of roughage in diet
• May show swelling in upper abdomen

Peptic Ulcer Disease Diagnostic Studies
• Endoscopy procedure most often used
• Determines degree of ulcer healing after treatment
• Tissue specimens can be obtained to identify H. pyloriand to rule out gastric cancer
• Tests for H. pylori
• Noninvasive tests
• Serum or whole blood antibody tests
• Immunoglobin G (IgG)
• Urea breath test
• Invasive tests
• Biopsy of stomach
• Rapid urease test
• Barium contrast studies
• Widely used
• X-ray studies
• Ineffective in differentiating a peptic ulcer from a malignant tumor
• Gastric analysis
• Identifying a possible gastrinoma
• Determining degree of gastric hyperacidity
• Evaluating results of therapy
• Laboratory analysis
• CBC
• Urinalysis
• Liver enzyme studies
• Serum amylase determination
• Stool examination

Peptic Ulcer Disease Collaborative Care
Medical regimen consists of
• Adequate rest
• Dietary modification
• Drug therapy
• Elimination of smoking
• Long-term follow-up care
• Aim of treatment program
• degree of gastric acidity
• Enhance mucosal defense mechanisms
• Minimize harmful effects on mucosa
• Generally treated in ambulatory care clinics
• Requires many weeks of therapy
• Pain disappears after 3 to 6 days

Healing may take 3 to 9 weeks

• Should be assessed by means of x-rays or endoscopic examination
• Moderation in daily activity is essential
• NSAIDs that are COX-2 inhibitors are used

Peptic Ulcer Disease Drug Therapy
Includes use of
• Antacids
• H2R blockers
• PPIs
• Antibiotics
• Anticholinergics
• Cytoproctective therapy

Recurrence of peptic ulcer is frequent
• Interruption or discontinuation of therapy can have detrimental results
• No drugs, unless prescribed by health care provider, should be taken
• Ulcerogenic effect

Histamine-2 receptor blocks (H2R blockers)
• Used to manage peptic ulcer disease
• Block action of histamine on H2receptors
• Decrease HCl acid secretion
• Decrease conversion of pepsinogen to pepsin
• Increase ulcer healing

Proton pump inhibitors (PPI)
• Block ATPase enzyme that is important for secretion of HCl acid

Antibiotic therapy
• Eradicate H. pyloriinfection
• No single agents have been effective in eliminating H. pylori

Antacids
• Used as adjunct therapy for peptic ulcer disease
• Increase gastric pH by neutralizing acid

Anticholinergic drugs
• Occasionally ordered for treatment
• Decrease cholinergic stimulation of HCl acid

Cytoprotective drug therapy
• Used for short-term treatment of ulcers
• Tricyclic antidepressants
• Serotonin reuptake inhibitors

NOW YOU CAN ALSO PUBLISH YOUR ARTICLE ONLINE.

SUBMIT YOUR ARTICLE/PROJECT AT articles@pharmatutor.org

Subscribe to Pharmatutor Job Alerts by Email

FIND OUT MORE ARTICLES AT OUR DATABASE