Gastrointestinal Health and Smoking Habits

Peptic Ulcer Disease

• Peptic ulcer disease is a condition where the digestive tract does not follow the one-way rule, leading to gastric ulcer and oesophagitis.
• In-coordination of nerves can lead to relaxation of the pylorus, allowing bile into the stomach, causing gastric ulcer.
• Vagus nerve stimulates excessive acid secretion, leading to increased acid secretion.
• Factors contributing to increased acid secretion include:
  • Nerve stimulation
  • Local factors (diseases of the stomach or diet)
  • Hormonal factors (tumors of the thyroid, pancreas, and adrenal glands)
• Other causes of peptic ulcer disease include:
  • Long-term use of NSAIDs
  • Infection by gram-negative bacteria (Helicobacter pylori)

Pathogenesis

• Two common forms of peptic ulcer disease:
  • Those associated with H. pylori
  • Those associated with the use of NSAIDs
• Patients may present with signs and symptoms ranging from benign to serious complications, including:
  • GI bleeding
  • Pyloric stenosis

Clinical Manifestations

• Upper abdominal pain
• Anorexia, weight loss, nausea, vomiting, and heartburn
• Complications:
  • Haemorrhage
  • Anemia
  • Pyloric stenosis
• Relapse can be reduced by eradication of H. pylori

Patient Assessment and Diagnosis

• Endoscopy
• Radiology
• Urea Breath Test

Complications of Peptic Ulcer

• Bleeding peptic ulcer
• Pyloric stenosis
• Late complications of peptic ulcer surgery

Management of Peptic Ulcer

• Key elements for successful management:
  • Helicobacter pylori eradication
  • Discontinuation of NSAIDs
• Treatment options:
  • Proton pump inhibitors (PPIs)
  • H2-receptor antagonists
  • Misoprostol
  • Sucralfate

Gastro-Esophageal Reflux Disease (GERD)

• Defined as any symptomatic clinical condition or histopathological alteration resulting from episodes of acid reflux, pepsin, and occasionally bile into the oesophagus from the stomach.
• Characteristic symptom: heartburn
• Mechanism of acid reflux is multifactorial, including:
  • Reduced tone of the lower oesophageal sphincter
• Treatment:
  • Standard dose of PPI therapy
  • Long-term management: least expensive but effective drug

Prevention of Peptic Ulcer

• Approaches to help prevent drug-induced upper GI ulceration:
  • Aspirin: use lowest possible dose, avoid other ulcerogenic medications, and use acetaminophen instead of aspirin for osteoarthritis in elderly patients.
  • Bisphosphonates: take with 8 oz of water, remain upright for 30 min after taking medication.
  • Corticosteroids: avoid concomitant use of NSAIDs or aspirin, if possible.
  • NSAIDs: use lowest possible dose, use least ulcerogenic NSAIDs, consider addition of PPI or misoprostol, and avoid other ulcerogenic medications.
  • Potassium chloride: microencapsulated formulation preferred, avoid slow-release wax-matrix formulations.
  • SSRIs: use alternative class of antidepressants, avoid concomitant use of NSAIDs if possible.
  • Tetracyclines: use tablet formulation rather than capsule formulation.

Future Treatment

• Immunization against H. pylori will be a future option in the management of peptic ulcer disease.

Patient Care

• Patient education:
  • Smoking delays ulcer healing
  • Anticholinergics, TCAs, and calcium channel blockers can delay ulcer healing
• Patient monitoring:
  • Treatment success in PUD is measured by review of the patient in terms of symptom control.
  • Patients should be warned of GIT risk before beginning NSAID or aspirin therapy.
  • Patients sensitive to penicillin need an alternative to amoxicillin.
  • Anaemic patients following bleeding ulcer are prescribed iron therapy.
  • Patients receiving eradication therapy should be advised of the need for a combination of 3 drugs for a short period of time.

Quiz about the effects of smoking on gastrointestinal health, including peptic ulcer and gastroesophageal reflux. Learn about the etiology and symptoms of these conditions.