git pud 2013

PEPTIC ULCER DISEASE

Dr. M SHEKHANI

AETIOLOGYAETIOLOGY

ContentsContents

DEFINITIONDEFINITION

PATHOPHYSIOLOGYPATHOPHYSIOLOGY

PREDISPOSING FACTORSPREDISPOSING FACTORS

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MANAGEMENTMANAGEMENT

ContentsContents

D.DIAGNOSISD.DIAGNOSIS

DIAGNOSTIC WORK-UPDIAGNOSTIC WORK-UP

MEDICATIONS LISTMEDICATIONS LIST

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• Mucosal defect in the lower oesophagus, stomach or duodenum, in the jejunum after surgical anastomosis to the stomach or, rarely, in the ileum adjacent to a Meckel’s diverticulum..

Definition:Definition:

Epidemiology:Epidemiology:

• M/F for DU 5:1 - 2:1, GU 2:1 or less.

• Chronic gastric ulcer is usually single; 90% on the lesser curve within the antrum or body-antral junctio.

• Chronic DU usually occurs in D1 just distal to the pyloric; 50% on anterior.

• GU/DU coexist in 10%

• > 1 PU is found in 10–15%.

PathophysiologyPathophysiology

H Pylori

NSAIDs

Smoking

9O% DU,70% GU.In DU infect D cells leading to hypergastrinemia&hyperacidity.

30%;Impair mucosal defence through inhibiting PGs.

> Complication & < healing.

HP>90% DU>70% GU

Smoking NSAIDs

H Pylori: in > 50% of gen population

?GeneticsRarely ZES

Pathophysiology: How HP produces PUD.Pathophysiology: How HP produces PUD.

NSAIDs use.

cagA

vacA

Adhesins (BabA)&(o

ipA)

•IL-1β expression

•Smoking

Bacterial factors:

Host genetic polymorphisms:

Clinical features:Clinical features:

Poor predictors of PUDPresence.

Poor predictors of PUDPresence.

40% vomiting

30% atypical

In some

Symptoms

R/Rs

Daily vomiting? GOO

Elderly on NSAIDs: unease;anorexia

Asymptomatic present with complications as GIB, Perforation.

Investigations:Investigations:

Endoscopy

1. For DU not needed because mostly benign except for HP diagnosis or if giant or atypical features( Crohns,TB,Lymphoma,cancer).

2. For GU needed BZ may be malignant.

HP test

Endoscopic biopsy:Endoscopic biopsy:

90%: Pan head or duodenum

50% multiple

½-2/3 malignant but slow growing

20-60% part of MEN1

Diagnosis: Serum gastrin 10-1000 fold increase& paradoxical inc with secretin. Localization by: EUS& SST Rec scintigraphy.

Features:Short historyComplicated more.Ulcers> in unusual sites, D2,Jej,eso.Unresponsive to trt.Recurs after surgery.Diarrhea in 50%.

Diagnosis:

ZES:GastrinomaZES:Gastrinoma

Drugs for PUD:Drugs for PUD:

Acid suppresants:

PPI/HSRAs/Antacids

Mucosal resistance enhancers

Both:

Sucralfate/Carbinoxolone.

Prpstaglandins.