ACID PEPTIC DISORDER Ss

ACID PEPTIC
PRESENTER – Dr. Sushant Dhadiwal DISORDER

CONTENTS
 Introduction
 Peptic ulcer
 Types
 Aetiology
 Pathophysiology
 DD
 Investigation
 Treatment
 GERD
 Symptoms
 Diagnostic test
 Treatment
INTRODUCTION
Acid peptic disorder include a number of conditions

whose pathophysiology is believed be the result of
damage from acid and pepsin activity in the gastric
secretions.
Mostly include –
1. Peptic ulcer
2. GERD
3
Acid peptic disorder
Common terminology
 Dysphagia – Difficulty in swallowing, caused by
obstruction of oesophagus
 Dyspepsia – Epigastric discomfort, fullness
 Odynophagia – Painful swallowing usually
associated with dyspepsia
 Heartburn – Burning sensation retrosternally
associated with reflex.
 Anorexia – Loss of appetite
 Haematemesis – Vomiting blood
 Melena – Passing off black terry, offensive stool
 Gastritis – Inflammation of gastric mucous
Acid peptic disorder 4
PEPTIC ULCER
• Peptic ulcer is the lesion in the mucosal lining

of the digestive tract, typically in the stomach
or duodenum, caused by the digestive action
of pepsin and stomach acid.

Types
1. Gastric Ulcer
2. Duodenal Ulcer

SITES
• Most of peptic ulcer occur either in the
duodenum or stomach
• Lower Oesophagus ( due to reflexing of gastric
content )
• Rarely in certain areas of small intestine

Aetiology
• Helicobacter Pylori – gram negative bacteria, can
live in stomach and duodenum
• Gastric Acid – needs to be present for ulcer to
form – activates pepsin and injures mucosa
• Decreased blood flow – causes decrease in mucus
production and bicarbonate synthesis, promote
gastric acid secretion
• NSAID – inhibit the production of prostaglandins
• Smoking – nicotine stimulates gastric acid
production

H. Pylori
• Gram (-) rod with flagella
• H pylori is most common
cause of PUD
• Transmission route – Fecal
& oral
• Secreates urase that
convert urea to ammonia
• Produces alkaline
environment enabling
survival in stomach
• Almost all duodenal and
2/3rd gastric ulcer pt
infected with H. pylori

RISK FACTORS
• Lifestyle – Smoking, Alcohol, Medication

• H. Pylori infection – 90% have this bacteria
Passed from person to person
• Age – Gastric – over 50
Duodenal – 30-40
• Gender – Duodenal are more in elder women
• Others - Stress

PATHOPHYSIOLOGY
H. Pylori infection NSAIDs
Release of cytokines, Topical and

lipopolsaccharides systemic effect
Hydrogen ion
and pepsin
Prostaglandin
Inflammatory cascade Mucus
initiated (cytokines, Blood flow
neutrophils, lymphocytes) Bicarbonte
Neutrophils
Mucosal damage
and ulceration

GASTRIC ULCER DUODENAL ULCER
Age Middle age 50 to 60 Any age specially 30 -40
Sex More in Female More in Male
Pain Epigastric radiate to back Epigastric discomfort
Onset Immediately after eating 2-3 hours after eating
Aggregated by Eating Hunger
Relived by Lying down or Vomiting Eating
Duration Few weeks 1-2 months
Vomiting Common Uncommon
Appetite Pt. afraid to eat Good
Weight Loss No loss
Haematoemesis 60% 40%

Melena 40% 60%
Differential Diagnosis
1. Hypoglycaemia – occurs 3-4 hrs after meal with
complaints of epigastric discomfort, nausea,
palpitation. The symptoms are relieved with
food. A blood sugar estimation with values below
60mg clinches the diagnosis
2. All gastric ulcer should be suspected malignant
unless proved
3. Hiatus hernia – The discomfort is usually at night
occurs within 1-2hrs only after lying down,
particularly after heavy meal and is relieved on
sitting up or walking about
4. Obesity
5. Z E Syndrome -
INVESTIGATION
1. Laboratory test – To determine H. Pylori present
in your body or not
2. Endoscopy
3. Barium X ray ( Coats digestive tract and makes
and ulcer more visible)

TREATMENT
 The medical therapy of Gastric & Duodenal ulcer
is similar
 The principles of medical treatment are –
a. Stop ulcerogenic drug –Aspirin,
phenylbutazone, corticosteroids
b. Adequate physical and mental rest
c. Diet
d. Antacids

o Rest – Gastric ulcer patients are best admitted for
rigorous medical therapy. Duodenal Ulcer patient
do not require admission and hospital care unless
–
a. there is associated emotional disturbance
b. persistent symptoms
c. Uncooperative patient

o Diet –
1. Small feeds every 3hrs

2. Chillies, meat soup extractives increase gastric
secretion are avoided
3. Smoking, Tobacco, Sour Fruits and Foods,
Alcohol perpetuate the symptoms
4. Use of garlic, ginger, coriander and jira add to
the flavour of food
5. Fat such as Oil and Ghee are permitted in
cooking but fried food is restricted

Antacid –
1. Sodium bicarbonate
2. Magnesium Hydroxide
3. Aluminium hydroxide
4. Magnesium Trisilicate

• PROTON PUMP INHIBITORS
1. Omeprazole
2. Pantoprazole
3. Rabeprazole
• H2 blocker – selectively reduces gastric secretion

1. Cimetidine
2. Rantidine

Other drugs
• Sucralfate – 1gm tab before food
• For stress – Diazepam 2 to 5mg BD or TID

GERD

INTRODUCTION
• GERD is defined as chronic symptoms of

heartburn, acid regurgitation or both or mucosal
damage produced by the abnormal reflex of
gastric content into the oesophagus.

SIGNS & SYMPTOMS
• Classical symptoms of GERD is heartburn and acid
regurgitation
• Symptoms often occurs after meals and can
increase when patient is recumbent
• Oesophegal –Heartburn, dysphagia, odynophagia,

regurgitation, belching
• Extraoesophageal –Cough, wheezing, hoarsness,

sore throat, epigastric pain, non cardiac chest pain

Alarming signs & symptoms
i. Dysphagia
ii. Early satiety
iii. GI bleeding
iv. Odynophagia
v. Vomiting
vi. Weight loss
vii. Iron deficiency anaemia

Factors Aggravates GERD
• Diet – Caffeine, fatty/spicy food, chocolate,

coffee, peppermint, citrus, alcohol
• Position/activity – bending, straining
• External pressure – pregnancy, tight clothing

Diagnostic test for GERD
1. Barium swallow
2. Endoscopy
3. pH monitoring
4. Oesophageal manometry
pH monitoring
Oesophageal manometry

TREATMENT
The goals of treatment in GERD are –
1. To relieve symptoms
2. Heal esophagitis
3. Prevent recurance of symptoms
4. Prevent complications

• Lifestyle modification
• Avoiding precipitating food (eg. Fatty food,
alcohol, caffeine)
• Avoiding recumbence for 3hrs postprandial
• Elevating the head of bed
• Quitting smoking
• Loosing weight
• Antacid
• PPI


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ACID PEPTIC

PRESENTER – Dr. Sushant Dhadiwal DISORDER

Acid peptic disorder include a number of conditions

• Peptic ulcer is the lesion in the mucosal lining

Acid peptic disorder 5

Acid peptic disorder 6

Acid peptic disorder 7

Acid peptic disorder 8

Acid peptic disorder 9

• Lifestyle – Smoking, Alcohol, Medication

Acid peptic disorder 10

Release of cytokines, Topical and

Acid peptic disorder 11

Age Middle age 50 to 60 Any age specially 30 -40

Sex More in Female More in Male

Pain Epigastric radiate to back Epigastric discomfort

Onset Immediately after eating 2-3 hours after eating

Aggregated by Eating Hunger

Relived by Lying down or Vomiting Eating

Duration Few weeks 1-2 months

Vomiting Common Uncommon

Appetite Pt. afraid to eat Good

Weight Loss No loss

Haematoemesis 60% 40%

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1. Small feeds every 3hrs

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• H2 blocker – selectively reduces gastric secretion

Acid peptic disorder 19

• Sucralfate – 1gm tab before food

• For stress – Diazepam 2 to 5mg BD or TID

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• GERD is defined as chronic symptoms of

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• Oesophegal –Heartburn, dysphagia, odynophagia,

• Extraoesophageal –Cough, wheezing, hoarsness,

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• Diet – Caffeine, fatty/spicy food, chocolate,

• Position/activity – bending, straining

• External pressure – pregnancy, tight clothing

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