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    Peptic Ulcer Disease: Dr. Haji Bahadar Pharmd, PHD Assistant Professor Khyber Medical University-Peshawar

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    ms khan
    Peptic ulcer disease is caused by Helicobacter pylori bacteria, NSAIDs, or rare conditions like Zollinger-Ellison Syndrome. It results in open sores in the stomach or duodenum lining. Diagnosis involves blood tests checking for elevated gastrin levels or a secretin stimulation test. Complications include bleeding and perforation. Treatment involves antibiotics to kill H. pylori, proton pump inhibitors to reduce acid secretion, and NSAIDs for pain relief.

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    Peptic Ulcer Disease: Dr. Haji Bahadar Pharmd, PHD Assistant Professor Khyber Medical University-Peshawar

    Uploaded by

    ms khan
    64 views24 pages
    Peptic ulcer disease is caused by Helicobacter pylori bacteria, NSAIDs, or rare conditions like Zollinger-Ellison Syndrome. It results in open sores in the stomach or duodenum lining. Diagnosis involves blood tests checking for elevated gastrin levels or a secretin stimulation test. Complications include bleeding and perforation. Treatment involves antibiotics to kill H. pylori, proton pump inhibitors to reduce acid secretion, and NSAIDs for pain relief.

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    11.Peptic ulcer disease

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    Peptic ulcer disease is caused by Helicobacter pylori bacteria, NSAIDs, or rare conditions like Zollinger-Ellison Syndrome. It results in open sores in the stomach or duodenum lining. Diagnosis involves blood tests checking for elevated gastrin levels or a secretin stimulation test. Complications include bleeding and perforation. Treatment involves antibiotics to kill H. pylori, proton pump inhibitors to reduce acid secretion, and NSAIDs for pain relief.

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    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    64 views24 pages

    Peptic Ulcer Disease: Dr. Haji Bahadar Pharmd, PHD Assistant Professor Khyber Medical University-Peshawar

    Uploaded by

    ms khan
    Peptic ulcer disease is caused by Helicobacter pylori bacteria, NSAIDs, or rare conditions like Zollinger-Ellison Syndrome. It results in open sores in the stomach or duodenum lining. Diagnosis involves blood tests checking for elevated gastrin levels or a secretin stimulation test. Complications include bleeding and perforation. Treatment involves antibiotics to kill H. pylori, proton pump inhibitors to reduce acid secretion, and NSAIDs for pain relief.

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    © All Rights Reserved
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    Download as pptx, pdf, or txt
    of 24

    Peptic ulcer disease

    Dr. Haji Bahadar PharmD, PhD


    Assistant Professor Khyber
    Medical University-Peshawar
    What is peptic ulcer?
    • Peptic ulcers are open sores that develop on
    the inside lining of stomach and the upper
    portion of small intestine.
    • Gastric ulcer: open sores that develop on the
    inside lining of stomach
    • Duodenal ulcer: open sores that develop on
    the inside lining of the upper portion of small
    intestine.
    Causes of peptic ulcer
    • Helicobacter pylori bacteria (H. pylori): H. pylori is the
    most common cause of gastric and duodenal ulcers.
    This bacterium damages the mucus that protects your
    stomach and small intestine, allowing for stomach acid
    to burn
    • nonsteroidal anti-inflammatory drugs (NSAIDs)
    • Zollinger-Ellison Syndrome (ZES) is a rare condition that
    affects the digestive tract. It’s characterized by the
    formation of tumors, called gastrinomas.  Gastrinomas
    produce excessive amounts of a hormone called gastrin.
    Gastrin triggers an overproduction of gastric acid.
    • Stress??:
    What is Gastrin?
    • Gastrin is a peptide hormone that stimulates
    secretion of gastric acid (HCl) by the parietal
    cells of the stomach and aids in gastric motility.
    It is released by G cells in the pyloric antrum of
    the stomach, duodenum, and the pancreas.
    The G cell is a type of cell in the stomach and
    duodenum that secretes gastrin. G cells are
    found deep within the pyloric glands of
    the stomach antrum, and in the pancreas.
    A gastrinoma is a tumor in the pancreas or duodenum that secretes excess
    of gastrin leading to ulceration in the duodenum, stomach and the small
    intestine
    Diagnosis of ZES
    • Blood tests. A sample of blood is analyzed to
    see elevated gastrin levels. While elevated
    gastrin. Serum gastrin levels have a reference
    range of 0-100 pg/mL.
    • the secretin test is the most sensitive and
    specific for the diagnosis of gastrinoma. If
    gastrin levels rise 120 pg within 15 minutes of
    secretin injection, the test has a sensitivity and
    specificity for Zollinger-Ellison syndrome of
    greater than 90%. secretin stimulation test self,
    The pathophysiology of PG-dependent NSAID-induced
    stomach injury
    • PGs play a critical role in maintaining
    gastric mucosal defense system, the
    inhibition of COX leading to decreased
    mucosal PGs is considered as the most
    important in the pathogenesis of NSAID-
    induced gastric damage. Aspirin inhibits
    COX irreversibly
    Complications
    • Bleeding (anemia)
    • Perforation
    DIAGNOSIS
    • ???????
    Regulation of Gastric acid secretion

    Gastric acid(HCl) production is regulated by


    acetylcholine and hormones gastrin and
    histamin. They stimulate the parietal cell to
    produce gastric acid. Acetylcholine and
    gastrin act directly on parietal cells and
    indirectly enterochromaffine-like cells(ECL)
    to secrete histamin

    Gastrin releasing peptide stimulates the release of Gastrin from the G cells of the
    stomach.
    Mechanism of acid secretion
    Gastric Acid Secretion
     Hydrogen ions generation: Hydrogen ions
    are generated from CO2 and H2O to form
    H+ and HCO3 ions (carbonic anhydrase)
     Bicarbonate ions are transported out in
    exchange for chloride 
     Hydrogen ion is pumped out of the cell,
    into the lumen, in exchange for potassium
    through the action of the proton pump
    (H+K+-ATPase pump)
    Drugs used peptic ulcer
    1. Drugs which neutralize acid(Antacids): Antacids neutralize
    stomach acids. These drugs typically contain a base such as carbonate or
    hydroxide combined with aluminum, magnesium, or calcium. The base
    combines with excess hydrogen ions (H) in the stomach and thus
    increases the pH
    2. Drugs which provide physical barrier
    • Sucralfate (Carafate, Sulcrate). Sucralfate is a
    disaccharide that exerts a cytoprotective effect
    on the stomach mucosa. Sucralfate may form
    a protective gel within the stomach that
    adheres to ulcers and shields them from the
    contents of the stomach.
    3. Drugs which decrease acid secretion
    1.Proton Pump Inhibitors
    • Omeprazole(Risek)
    • Esomeprazole (Nexium),
    • Lansoprazole
    2. H2 receptor blockers
    • Rabeprazole
    • Pantoprazole
    • Dexlansoprazole
    H2 receptor blockers
    Histamine stimulates specific receptors on stomach parietal
    cells to increase gastric acid secretion. These histamine
    receptors are classified as H2 receptors. H2 antagonists, or
    blockers, prevent the histamine activated release of gastric acid.
    Side effects:
    • headache
    • nausea
    • diarrhea
    • abdominal pain
    • dizziness,
    • Constipation
    • Cimetidine has been associated with gynaecomastia (breast
    enlargement in men)and anti androgenic properties.
    Mechanism of action of PPIs
    • PPIs drug inhibit the H, K -ATPase enzyme responsible
    for secreting acid from gastric parietal cells of the
    stomach.
    • Side effects: The most common side effects of proton pump inhibitors are:
    • Headache.
    • Diarrhea.
    • Constipation.
    • Abdominal pain.
    • Flatulence.
    • Fever.
    • Vomiting.
    • Nausea.
    Treatment of
    H. Pylori

    sos: si opus sit, if needed

    tid:ter in die (three times a


    day)
    bid: bis in die or two times a day
    qid:quater in die( four times a
    day)
    Stat: urgent

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