First aid-heat-stroke in Urdu
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Peptic ulcer disease refers to mucosal erosions equal to or greater than 5 mm in the stomach or proximal duodenum, caused primarily by an imbalance between gastric acid/pepsin secretion and mucosal defense mechanisms. The most common etiologies include Helicobacter pylori infection, chronic use of NSAIDs, and physiological stress.
Classification of Peptic Ulcers
Based on Location
Gastric Ulcers Occur in the stomach lining.
Duodenal Ulcers Occur in the first part of the small intestine (duodenum).
Based on Etiology
H. pyloriAssociated Ulcers
NSAID-Induced Ulcers
Stress-Related Mucosal Disease (SRMD)
ZollingerEllison Syndrome (gastrinoma-related)
Cushings Ulcer (due to intracranial injury)
Curlings Ulcer (seen in burn patients)
Pharmacological Management
1. Acid Suppression Therapy
Class Examples Mechanism
Proton Pump Inhibitors (PPIs) Omeprazole, Pantoprazole Irreversibly inhibit H+/K+ ATPase pump
H2-Receptor Antagonists Ranitidine, Famotidine Block histamine-mediated gastric acid secretion
2. Mucosal Protective Agents
Class Examples Mechanism
Prostaglandin Analogues Misoprostol Increases mucus & bicarbonate; decreases acid; protects mucosa
Mucosal Coating Agents Sucralfate Forms protective barrier over ulcer site
Bismuth Compounds Bismuth subsalicylate Antimicrobial, mucosal protective, and anti-inflammatory
3. Eradication Therapy (for H. pylori)
Combination of:
PPI + Two Antibiotics (e.g., amoxicillin + clarithromycin OR metronidazole + tetracycline)
Duration: 714 days depending on local guidelines
See BNF regimens above for detailed protocols
4. Cytoprotective/Adjunctive Agents
Class Examples Role in PUD
Somatostatin Analogues Octreotide Used in bleeding ulcers; reduces splanchnic blood flow and gastric secretions
Antacids Magnesium hydroxide, Aluminium hydroxide Neutralize gastric acid; provide symptomatic relief
Non-Pharmacologic Measures
Avoid NSAIDs, smoking, alcohol, and spicy foods
Small, frequent meals in symptomatic patients
Stress reduction
Endoscopic therapy in case of bleeding or perforation
Surgical Indications (rarely needed)
Perforated ulcer
Gastric outlet obstruction
Refractory ulcers not responding to medical therapy
Severe bleeding unresponsive to endoscopic management
Summary
Peptic ulcer disease is primarily driven by H. pylori infection and NSAID use, with duodenal ulcers more common than gastric. Treatment is tailored based on etiology and includes acid suppression, H. pylori eradication, and mucosal protection. Advanced cases may require somatostatin analogues for hemorrhage control or surgery for complications. Prostaglandin analogues like misoprostol are especially valuable in preventing NSAID-induced ulcers.INTERPRETATION OF LABORATORY INVESTIGATIONS.pptx
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