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Questions and Answers
What is a potential complication of using Diclofenac to induce birth?
What is a non-pharmacological factor that can delay ulcer healing?
What is a common symptom experienced by patients after eradication therapy?
What is a medication that should be avoided in patients sensitive to penicillin?
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What is the primary goal of patient monitoring in PUD?
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What is a potential consequence of taking anticholinergics, TCAs, and calcium channel blockers?
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What is a future treatment option for peptic ulcer disease?
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What is a warning that patients should be given before starting NSAID or aspirin therapy?
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What is a treatment that may be prescribed to anaemic patients following bleeding ulcer?
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What is an important instruction that patients receiving eradication therapy should be given?
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Study Notes
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.
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Description
Quiz about the effects of smoking on gastrointestinal health, including peptic ulcer and gastroesophageal reflux. Learn about the etiology and symptoms of these conditions.
