INTRODUCTION The Acid Peptic disease definition says that it is an ulcer of an area of the gastrointestinal tract that is usually

acidic and thus extremely painful. It is also known as peptic ulcer, Ulcus Pepticum and PUD. As many as 70-90% of Acid Peptic disease are associated with Helicobacter pylori, a spiral-shaped bacterium that lives in the acidic environment of the stomach, however, only 40% of those cases go to a doctor. Acid Peptic disease can also be caused or worsened by drugs such as aspirin and other NSAIDs. Contrary to general belief, more Acid Peptic disease arises in the duodenum (first part of the small intestine, just after the stomach) rather than in the stomach. About 4% of stomach ulcers are caused by a malignant tumor, so multiple biopsies are needed to exclude cancer. Duodenal ulcers are generally benign. Esophageal ulcers occur as s result of the backflow of HCI from the stomach into the esophagus (gastroesophageal reflux disease (GERD). Classification of acid peptic disease by region/location Duodenum (called duodenal ulcer), Esophagus (called esophageal ulcer), Stomach (called gastric ulcer), Meckel's diverticulum (called Meckel's diverticulum ulcer; is very tender with palpation). Modified Johnson Classification of peptic ulcers:Type I: Ulcer along the body of the stomach, most often along the lesser curve at incisura angularis along the locus minoris resistentiae. Type II: Ulcer in the body in combination with duodenal ulcer associated with acid oversecretion. Type III: In the pyloric channel within 3 cm of pylorus associated with acid oversecretion. Type IV: Proximal gastroesophageal ulcer Type V: Can occur throughout the stomach associated with chronic NSAID use (such as aspirin). The most common cause of peptic ulcer is infection with the H pylori bacteria. Other causes of peptic ulcers include alcohol use, tobacco use, and prolonged use of medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) that can damage the lining of the stomach and duodenum. Severe illness and radiation therapy may also be associated with peptic ulcers. For many years, excess acid was believed to be the major cause of ulcer

disease. Accordingly, treatment emphasis was on neutralizing and inhibiting the secretion of stomach acid. While acid is still considered significant in ulcer formation, the leading cause of ulcer disease is currently believed to be infection of the stomach by a bacteria called "Helicobacter pyloricus" (H. pylori). Another major cause of ulcers is the chronic use of anti-inflammatory medications, commonly referred to as NSAIDs (nonsteroidal anti-inflammatory drugs), including aspirin. Cigarette smoking is also an important cause of ulcer formation and ulcer treatment failure. An H. pylori bacterium is very common, infecting more than a billion people worldwide. It is estimated that half of the United States population older than age 60 has been infected with H. pylori. Infection usually persists for many years, leading to ulcer disease in 10 % to 15% of those infected. H. pylori is found in more than 80% of patients with gastric and duodenal ulcers. While the mechanism of how H. pylori causes ulcers is not well understood, elimination of this bacteria by antibiotics has clearly been shown to heal ulcers and prevent ulcer recurrence. NSAIDs are medications for arthritis and other painful inflammatory conditions in the body. Aspirin, ibuprofen (Motrin), naproxen (Naprosyn), and etodolac (Lodine) are a few of the examples of this class of medications. Prostaglandins are substances which are important in helping the gut linings resist corrosive acid damage. NSAIDs cause ulcers by interfering with prostaglandins in the stomach. Cigarette smoking not only causes ulcer formation, but also increases the risk of ulcer complications such as ulcer bleeding, stomach obstruction and perforation. Cigarette smoking is also a leading cause of ulcer medication treatment failure. Contrary to popular belief, alcohol, coffee, colas, spicy foods, and caffeine have no proven role in ulcer formation. Similarly, there is no conclusive evidence to suggest that life stresses or personality types contribute to ulcer disease.

Acid Peptic disease Symptoms, Abdominal pain, classically epigastric with severity relating to mealtimes, after around 3 hours of taking a meal (duodenal ulcers are classically relieved

by food, while gastric ulcers are exacerbated by it) comes under Acid Peptic disease Symptoms. Bloating and abdominal fullness; Water brash (rush of saliva after an episode of regurgitation to dilute the acid in esophagus);Nausea, and copious vomiting; Loss of appetite and weight loss; Hematemesis (vomiting of blood); this can occur due to bleeding directly from a gastric ulcer, or from damage to the esophagus from severe/continuing vomiting. Melena (tarry, foul-smelling feces due to oxidized iron from hemoglobin);Rarely, an ulcer can lead to a gastric or duodenal perforation, which leads to acute peritonitis. This is extremely painful and requires immediate surgery. The pain caused by Acid Peptic disease can be felt anywhere from the navel up to the breastbone, it may last from few minutes to several hours and it may be worse when the stomach is empty. Also, sometimes the pain may flare at night and it can commonly be temporarily relived by eating foods that buffer stomach acid or by taking anti-acid medication. However, Acid Peptic disease symptoms may be different for every sufferer. The diagnosis is mainly established based on the characteristic symptoms of Acid Peptic disease. The stomach pain is usually the first to signal a peptic ulcer. In some cases, doctors may treat ulcers without diagnosing them with specific tests and observe if the symptoms resolve, meaning their primary diagnosis was accurate. Confirming the diagnosis of Acid Peptic disease is made with the help of tests such as endoscopies or barium contrast x-rays. The tests are typically ordered if the symptoms do not resolve after a few weeks of treatment, or when they first appear in a person who is over age 45 or who has other symptoms such as weight loss, because stomach cancer can cause similar symptoms. Also, when severe ulcers resist treatment, particularly if a person has several ulcers or the ulcers are in unusual places, a doctor may suspect an underlying condition that causes the stomach to overproduce acid. An esophagogastroduodenoscopy (EGD), a form of endoscopy, also known as a gastroscopy, is carried out on patients in whom a peptic ulcer is suspected. By direct visual identification, the location and severity of an ulcer can be

described. Moreover, if no Acid Peptic disease is present, EGD can often provide an alternative diagnosis. One of the reasons why blood tests are not reliable on establishing an accurate peptic ulcer diagnosis on their own is their inability to differentiate between past exposure to the bacteria and current infection. In clinical management, Younger patients with Acid Peptic disease like symptoms are often treated with antacids or H2 antagonists before EGD is undertaken. Bismuth compounds may actually reduce or even clear organisms, though the warning labels of some bismuth subsalicylate products indicate that the product should not be used by someone with an ulcer. Patients who are taking nonsteroidal anti-inflammatory (NSAIDs) may also be prescribed a prostaglandin analogue (Misoprostol) in order to help prevent Acid Peptic disease, which may be a side-effect of the NSAIDs. When H. pylori infection is present, the most effective Acid Peptic disease treatments are combinations of 2 antibiotics (e.g. Clarithromycin, Amoxicillin, Tetracycline, Metronidazole) and 1 proton pump inhibitor (PPI), sometimes together with a bismuth compound. In complicated, treatmentresistant cases, 3 antibiotics (e.g. amoxicillin + clarithromycin + metronidazole) may be used together with a PPI and sometimes with bismuth compound. An effective first-line therapy for uncomplicated cases would be Amoxicillin + Metronidazole + Pantoprazole (a PPI). In the absence of H. pylori, long-term higher dose PPIs are often used. Acid Peptic disease Treatment of H. pylori usually leads to clearing of infection, relief of symptoms and eventual healing of ulcers. Recurrence of infection can occur and retreatment may be required, if necessary with other antibiotics. Since the widespread use of PPI's in the 1990s, surgical procedures (like "highly selective vagotomy") for uncomplicated peptic ulcers became obsolete. Perforated Acid Peptic disease treatment comes with a surgical option and requires surgical repair of the perforation. Most bleeding ulcers of Acid Peptic disease treatment require endoscopy to urgently stop bleeding with cautery, injection, or clipping.

Nursing managements are, Monitor the patient for signs of bleeding through fecal occult blood, vomiting, persistent diarrhea, and change in vital signs. Monitor intake and output. Monitor the patients hemoglobin, hematocrit, and electrolyte levels. Administered prescribed I.V. fluids and blood replacements if acute bleeding is present. Maintain nasogastric tube for acute bleeding, perforation, and postoperatively, monitor tube drainage for amount and color. Perform saline lavage if ordered for acute bleeding. Encourage bed rest to reduce stimulation that may enhance gastric secretion. Provide small, frequent meals to prevent gastric distention if not actively bleeding. Watch for diarrhea caused by antacids and other medications. Restrict foods and fluids that promote diarrhea and encourage good perineal care. Advise patient to avoid extremely hot or cold food and fluids, to chew thoroughly, and to eat in a leisurely fashion to reduce pain. Administer medications properly and teach patient dose and duration of each medication. Advise patient to modify lifestyle to include health practices that will prevent recurrences of ulcer pain and bleeding.