Acid peptic disease
Acid peptic disease.( Helicobacter pylori. Peptic ulcer )
Incidence-10% of all adult males.
Heredity.Strong family history with gastric ulcers, but less strong family history with duodenal ulcers.
Acid-pepsin versus mucosal resistance.
Prostaglandins play a central role in mucosal resistance. They regulate the release of mucosal bicarbonate and mucus, inhibit parietal cell secretion and are important in maintaining mucosal blood flow. This explains the ulcerogenic properties of non-steroidal anti-inflammatory drugs (NSAIDs).
Reflux of bile and intestinal contents into stomach due to poorly functioning pyloric sphincter. Other risk factors include smoking and alcohol consumption.
Aetiology of acute and stress ulcers
Peptic ulcer is a chronic condition with a natural history of spontaneous relapses and remissions lasting for decades or even life.
Water-brash (excessive salivation), heart burns, loss of appetite and vomiting.
Upper gastrointestinal bleed.
Double contrast barium meal may show the ulcer as a crater or as a deformed duodenal cap.
Tests for H. pylori
III.Histamine H2-receptor antagonists
IV.Proton pump inhibitors
Mechanism of action
Efficacy in peptic ulcer disease
V. Prostaglandin analogues
VI.Colloidal bismuth compounds
Side effects include blackening of tongue, teeth and face, and bismuth toxicity (neurotoxicity).
Treatment—patient should be asked to avoid simple carbohydrate food and also to take meals in small amounts at