PEPTIC ULCER

INTRODUCTION

  • Peptic ulcer is defined as break in the continuity of the mucus membrane of GI tract due to excess secretion of acid.

  • most common causative factor is Helicobacter pylori infection

TWO TYPES ACCORDING TO SITE,

  • Gastric ulcer - stomach

  • Duodenal ulcer - duodenum

PREVALENCE

  • Higher in developing countries.

  • Decrease in western countries, due to use of H. pylori Eradication therapy.

  • Duodenal ulcer : Male / Female : 5:1 to 2:1

  • Gastric ulcer : Male / Female : 2:1 to less

  • Male > Female

ETIOPATHOGENESIS

1.H.pylori


2. NSAIDs - Direct injury

3. Smoking - More chances of gastric ulcer than duodenal ulcer.


PATHOPHYSIOLOGY OF DUODENAL ULCER


















SIGN AND SYMPTOMS

  • Burning stomach pain

  • Feeling of fullness, bloating or belching

  • Fatty food intolerance

  • Heartburn

  • Nausea

  • Vomiting or vomiting blood — which may appear red or black

  • Dark blood in stools, or stools that are black or tarry

  • Trouble breathing

  • Feeling faint

  • Nausea or vomiting

  • weight loss

  • loss of appetite

RISK FACTOR

  • Smoke Smoking may increase the risk of peptic ulcers in people who are infected with H. pylori.

  • Drink alcohol Alcohol can irritate and erode the mucous lining of your stomach, and it increases the amount of stomach acid that's produced.

  • Have untreated stress

  • Eat spicy foods

COMPLICATION

  • Internal bleeding Bleeding can occur as slow blood loss that leads to anemia or as severe blood loss that may require hospitalization or a blood transfusion. Severe blood loss may cause black or bloody vomit or black or bloody stools.

  • Infection Peptic ulcers can eat a hole through (perforate) the wall of your stomach or small intestine, putting you at risk of serious infection of your abdominal cavity (peritonitis).

  • Obstruction Peptic ulcers can block passage of food through the digestive tract, causing you to become full easily, to vomit and to lose weight through either swelling from inflammation or scarring.

PREVENTION

  • Protect yourself from infections It's not clear just how H. pylori spreads, but there's some evidence that it could be transmitted from person to person or through food and water. You can take steps to protect yourself from infections, such as H. pylori, by frequently washing your hands with soap and water and by eating foods that have been cooked completely.

  • Use caution with pain relievers If you regularly use pain relievers that increase your risk of peptic ulcer, take steps to reduce your risk of stomach problems. For instance, take your medication with meals. Work with your doctor to find the lowest dose possible that still gives you pain relief. Avoid drinking alcohol when taking your medication, since the two can combine to increase your risk of stomach upset. If you need an NSAID, you may need to also take additional medications such as an antacid, a PPI, an acid blocker or cytoprotective agent. A class of NSAIDs called COX-2 inhibitors may be less likely to cause peptic ulcers, but may increase the risk of heart attack.

DIAGNOSIS AND INVESTIGATION

  • Laboratory tests for H. pylori recommend tests to determine whether the bacterium H. pylori is present in your body. Investigation may look for H. pylori using a blood, stool or breath test. The breath test is the most accurate. Blood tests are generally inaccurate and should not be routinely used.

  • Endoscopy may use a scope to examine your upper digestive system (endoscopy). During endoscopy, your doctor passes a hollow tube equipped with a lens (endoscope) down your throat and into your esophagus, stomach and small intestine. Using the endoscope, your doctor looks for ulcers.

  • Upper gastrointestinal series Sometimes called a barium swallow, this series of X-rays of your upper digestive system creates images of your esophagus, stomach and small intestine. During the X-ray, you swallow a white liquid (containing barium) that coats your digestive tract and makes an ulcer more visible.

HOMOEOPATHIC THERAPEUTICS

  • ARSENIC- Stomach tender to pressure ; even to the slightest touch ; gnawing in pit of stomach ; Vomiting of blood , with fainting before and after it; Pain in stomach while or immediately after eating.

  • Bismuth - pressure as from a load of one spot , with pressure in spine, > by bending backward .

  • Hamamelis - Hemorrhage , blood black ; violent throbbing or trembling of stomach ; soreness of abdomen ; tarry stool.

  • Argentum nitricum - For abdominal bloating with belching and pain.

  • ABIES CANADENSIS - Gnawing, hungry faint feeling at the epigastrium. Burning and distension of stomach with palpitation. Tendency to eat far beyond the capacity for digestion. Great appetite, craving for meat, pickles, radish, turnips, coarse food. Flatulence disturbs the heart’s action. Wants to lie down all the time.

  • Carbo-veg -Weak digestion, simplest food disagrees, excessive accumulation of gas in stomach and intestines ( upper abdomen), sensation as if abdomen would burst. Eructations give temporary relief. Haematemesis and malena. Bad effects of fatty food, pork, butter, late supper, debauch, salted meat, spoiled fish or meat. Frequent involuntary cadaverous smelling stools. Carcinoma of stomach, late stages of disease. Complaints from loss of vital fluids, broken down constitution.

  • CONDURANGO - Gastric ulcer, carcinoma of stomach. Constant burning pains. Vomiting of food, burning behind sternum, where food seems to stick. Stricture of oesophagus. Chronic gastric catarrh. Painful cracks at corners of mouth.

  • Kali - bich - Gastric ulcer ; punched out or round ulcer of stomach. Pain immediately after eating. Pain in small spots, can be covered with the point of finger; appears and disappears suddenly, rapidly shifting. Neuralgia every day at the same hour. Weight in pit of stomach, flatulence, vomiting of stringy, ropy mucus and blood. Loss of appetite.

  • Lycopodium - Canine hunger, the more he eats, the more he craves, wakes up at night feeling hungry. Excessive accumulation of flatulence, especially in lower abdomen. Good appetite, but a few mouth ful fills up to the throat. Everything tastes sour. Heartburn, sour vomiting. Constipation with ineffectual urging. Prefers warm food and drinks. Very sensitive, cannot endure opposition. Avaricious, irritable, cross.

  • NUX-VOMICA - Gastric ulcer; Pain or pressure in stomach an hour or two after eating as from a stone. Nausea constant, after eating, ineffectual desire to vomit, feels if I could only vomit, I would be much better. Alternate constipation and diarrhea. Frequent ineffectual desire for stool. Sour bitter eructations. Bad effects of coffee, tobacco, alcohol, highly spiced food, over eating, long continued mental exertion, sedentary habits, anxiety, worry. Literary, studious, responsible persons.

  • Petroleum -Duodenal ulcer ; Ravenous hunger, must rise at night to eat. Pain abdomen > by constant eating <empty stomach, eating cabbage. Heartburn, nausea. Diarrhea only in day time. Symptoms appear and disappear suddenly;

  • Uranium Nitricum - Gastric and duodenal ulcers. Ravenous appetite, eating followed by flatulence. Boring pain in pyloric region. Excessive thirst, nausea, vomiting. Burning pains. Abdomen distended. Great emaciation, debility. Diabetes, ascites, nephritis, hypertension, degeneration of liver.