Acid Peptic Disease

Also known by the names of peptic ulcer disease, H. pylori ulcer, Peptic ulcers or simply peptic disease.

Causes:

  • Acid (HCl) hypersecretion
  • Helicobacter pylori
  • Ingestion of NSAID

Types:

  • Duodenal ulcer
  • Gastric ulcer
  • Complicated peptic ulcer – perforated gastric or duodenal ulcer
  • Pyloric stenosis
  • Haematemesis.

Clinical Features:

  • Intermittent epigastric pain, which may radiate to back.
  • Periodicity -> symptoms recovering after weeks or months.
  • Bleeding – causing 1. Anaemia 2. Haematemesis 3. Melena
  • Exam shows epigastric tenderness.

Treatment:

  1. Advise for modifying of lifestyle — e.g. cessation of cigarette smoking
  2. H2 – receptor antagonists e.g. ranitidine, cimetidine
  3. Proton–Pump Inhibitors e.g. omeprazole.Relapses with above therapy are Universal
  4. H. Pylori Eradication Therapy.1) Amoxil + metronidazole.2) Clarithromycin + metronidazole
  5. Surgical Treatment in case of complication like perforation failure of conservative management of bleeding peptic ulcer and pyloric obstruction.

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