Peptic ulcer disease

Dr. Haji Bahadar PharmD, PhD

Assistant Professor Khyber
Medical University-Peshawar
 What is peptic ulcer?
• Peptic ulcers are open sores that develop on
the inside lining of stomach and the upper
portion of small intestine.
• Gastric ulcer: open sores that develop on the
inside lining of stomach
• Duodenal ulcer: open sores that develop on
the inside lining of the upper portion of small
intestine.
 Causes of peptic ulcer
• Helicobacter pylori bacteria (H. pylori): H. pylori is the
most common cause of gastric and duodenal ulcers.
This bacterium damages the mucus that protects your
stomach and small intestine, allowing for stomach acid
to burn
• nonsteroidal anti-inflammatory drugs (NSAIDs)
• Zollinger-Ellison Syndrome (ZES) is a rare condition that
affects the digestive tract. It’s characterized by the
formation of tumors, called gastrinomas.  Gastrinomas
produce excessive amounts of a hormone called gastrin.
Gastrin triggers an overproduction of gastric acid.
• Stress??:
 What is Gastrin?
• Gastrin is a peptide hormone that stimulates
secretion of gastric acid (HCl) by the parietal
cells of the stomach and aids in gastric motility.
It is released by G cells in the pyloric antrum of
the stomach, duodenum, and the pancreas.
The G cell is a type of cell in the stomach and
duodenum that secretes gastrin. G cells are
found deep within the pyloric glands of
the stomach antrum, and in the pancreas.
A gastrinoma is a tumor in the pancreas or duodenum that secretes excess
of gastrin leading to ulceration in the duodenum, stomach and the small
intestine
 Diagnosis of ZES
• Blood tests. A sample of blood is analyzed to
see elevated gastrin levels. While elevated
gastrin. Serum gastrin levels have a reference
range of 0-100 pg/mL.
• the secretin test is the most sensitive and
specific for the diagnosis of gastrinoma. If
gastrin levels rise 120 pg within 15 minutes of
secretin injection, the test has a sensitivity and
specificity for Zollinger-Ellison syndrome of
greater than 90%. secretin stimulation test self,
The pathophysiology of PG-dependent NSAID-induced
stomach injury
• PGs play a critical role in maintaining
gastric mucosal defense system, the
inhibition of COX leading to decreased
mucosal PGs is considered as the most
important in the pathogenesis of NSAID-
induced gastric damage. Aspirin inhibits
COX irreversibly
 Complications
• Bleeding (anemia)
• Perforation
 DIAGNOSIS
• ???????
 Regulation of Gastric acid secretion

Gastric acid(HCl) production is regulated by

acetylcholine and hormones gastrin and
histamin. They stimulate the parietal cell to
produce gastric acid. Acetylcholine and
gastrin act directly on parietal cells and
indirectly enterochromaffine-like cells(ECL)
to secrete histamin

Gastrin releasing peptide stimulates the release of Gastrin from the G cells of the
stomach.
Mechanism of acid secretion
 Gastric Acid Secretion
 Hydrogen ions generation: Hydrogen ions
are generated from CO2 and H2O to form
H+ and HCO3 ions (carbonic anhydrase)
 Bicarbonate ions are transported out in
exchange for chloride 
 Hydrogen ion is pumped out of the cell,
into the lumen, in exchange for potassium
through the action of the proton pump
(H+K+-ATPase pump)
 Drugs used peptic ulcer
1. Drugs which neutralize acid(Antacids): Antacids neutralize
stomach acids. These drugs typically contain a base such as carbonate or
hydroxide combined with aluminum, magnesium, or calcium. The base
combines with excess hydrogen ions (H) in the stomach and thus
increases the pH
 2. Drugs which provide physical barrier
• Sucralfate (Carafate, Sulcrate). Sucralfate is a
disaccharide that exerts a cytoprotective effect
on the stomach mucosa. Sucralfate may form
a protective gel within the stomach that
adheres to ulcers and shields them from the
contents of the stomach.
 3. Drugs which decrease acid secretion
1.Proton Pump Inhibitors
• Omeprazole(Risek)
• Esomeprazole (Nexium),
• Lansoprazole
2. H2 receptor blockers
• Rabeprazole
• Pantoprazole
• Dexlansoprazole
 H2 receptor blockers
Histamine stimulates specific receptors on stomach parietal
cells to increase gastric acid secretion. These histamine
receptors are classified as H2 receptors. H2 antagonists, or
blockers, prevent the histamine activated release of gastric acid.
Side effects:
• headache
• nausea
• diarrhea
• abdominal pain
• dizziness,
• Constipation
• Cimetidine has been associated with gynaecomastia (breast
enlargement in men)and anti androgenic properties.
 Mechanism of action of PPIs
• PPIs drug inhibit the H, K -ATPase enzyme responsible
for secreting acid from gastric parietal cells of the
stomach.
• Side effects: The most common side effects of proton pump inhibitors are:
• Headache.
• Diarrhea.
• Constipation.
• Abdominal pain.
• Flatulence.
• Fever.
• Vomiting.
• Nausea.
 Treatment of
H. Pylori

sos: si opus sit, if needed

tid:ter in die (three times a

day)
bid: bis in die or two times a day
qid:quater in die( four times a
day)
Stat: urgent