ULCER PRESENTATION

Ulcers

NATASHA MC HUGH │CATRINA ROONEY │REMILEKUN ADEGNIKA

START

INDEX

dEFINITION

other treatments

Ppi MECHANISM

ppI HISTORY

SYMPTOMS

prevention

CAUSES

h2 mechanism

cOMPLICATIONS

h2 history

antibiotic agents

dIAGNOSIS

TYPES of ulcers

Peptic ulcers occur when acid in the digestive tract eats away at the inner surface of the stomach or small intestine, creating a painful open sore that may bleed. The digestive tract is coated with a mucous layer that is protective against acid. However, if the amount of acid is increased or the amount of mucus is decreased, an ulcer could develop (Malfertheiner et al. 2009).

2. Duodenal

3. Gastric

1. Oesophageal

Painful sores found within the stomach lining. Affect both the stomach and small intestines (Dunlap and Patterson 2019).

Rarely, a peptic ulcer may develop just above the stomach in the oesophagus, referred to as oesophageal ulcers (Dunlap and Patterson 2019).

The majority of ulcers are located in the small intestine, referred to as duodenal ulcers (Dunlap and Patterson 2019).

SYMPTOMS of ulcers

Dull or burning pain

Numerous individuals with ulcers display no symptoms at all. However, a dull or burning pain in your stomach is the most common symptom of a peptic ulcer (Najm 2011). The pain most often: · occurs when the stomach is empty—such as between meals or during the night · stops briefly when eating or subsequent to antacids · lasts for minutes to hours · comes and goes for several days, weeks, or months (Najm 2011).

CAUSES OF ULCERS

Taking other medications

Helicobacter pylori

3.

1.

Taking certain other medications along with NSAIDs, inclusive of steroids, anticoagulants, low-dose aspirin, selective serotonin reuptake inhibitors (SSRIs), can greatly increase the chance of developing ulcers (Khotib et al. 2019).

Inhabit the mucous layer that coats and protects tissues that line the stomach and small intestine. However, can cause inflammation of the stomach's inner layer, producing an ulcer (Narayanan et al. 2018).

4.

Rare cancerous & non-cancerous tumours

Regular use of NSAIDs

2.

Individuals who have Zollinger-Ellison syndrome (ZES) develop peptic ulcers caused by tumours. A child who has a parent with multiple endocrine neoplasia type 1 is also more likely to have Zollinger-Ellison syndrome (Lee et al. 2019).

Aspirin & other nonsteroidal anti-inflammatory drugs can irritate the lining of the stomach and small intestine & interfere with blood clotting, which is of importance when ulcers bleed (Chen et al. 2019).

Complications of ulcers

3.

2.

4.

Internal bleeding

Gastric obstruction

1.

Perforation

Gastric cancer

Perforation of the stomach or small intestine, putting an individual at risk of peritonitis. Infection may spread into the blood, causing sepsis & risk of multiple organ failure (Xu et al. 2020).

Peptic ulcers can block passage of food, causing one to become full easily, to vomit and to lose weight either through swelling from inflammation or through scarring (Morita et al. 2020).

Studies have shown that people infected with H. pylori have an increased risk of gastric cancer (Rawla and Barsouk 2019).

Occurs when an ulcer develops at the site of a blood vessel. If an ulcer becomes perforated, bleeding occurs. Bleeding from an ulcer may be slow and go unnoticed or can cause life-threatening haemorrhage (Xu et al. 2020).

DIAGNOSIS OF ULCERS

Endoscopic Biopsy

H. pylori Breath Test

3.

1.

Drink a clear liquid and breathe into a bag. If  H. pylori  is present, sample will contain higher-than-normal levels of carbon dioxide (Beresniak et al. 2020).

A piece of stomach tissue is removed so it can be analysed in a lab (Kavitt et al. 2019).

4.

2.

Endoscopy (EDG)

Barium Swallow

A thin, lighted tube is inserted through the mouth and into the stomach and the duodenum. Employed to assess for ulcers, bleeding, and any tissue that looks abnormal (Elkheshen et al. 2020).

Drink a thick white liquid (barium), coating the upper gastrointestinal tract and enables viewing of the stomach and small intestine on X-rays (Ishii et al. 2019).

Protein pump inhibitors mechanism of action

Powerful acid blocking drugs

PPIs are typically taken in combination with two antibiotics. Common PPIs include esomeprazole under the brand name Nexium® or lansoprazole. (Gwee et al. 2018).

HISTORY OF PROTEIN PUMP INHIBITORS

1970

1975

1988

1979

1992

proton pump inhibitor structure

Proton pump inhibtor (PPI)

Molecular structure of the proton pump inhbitor (PPI) omeprazole

HISTAMINE RECEPTOR antagonists MECHANISM OF ACTION

Histamin Receptor Antagonists

H2 blockers function as competitive antagonists & inclusive of cimetidine under the brand name Tagamet®, famotidine under the brand name Zantac®, nizatidine under the brand name Axid® (MacFarlane 2018).

HISTAMINE RECEPTOR antagonists MECHANISM OF ACTION

Histamin Receptor Antagonists

A useful on-demand treatment of occasional symptoms (Cooper Mourad and Koroukian 2003).

HISTORY OF HISTAMINE RECEPTORS antagonists

1964

1964

1972

1967

1976

histamine receptor antagonists structure

Histamine Receptor Antagonist

Molecular structure of the histamine receptor blocker Ranitidine

ANTIBIOTIC AGENTS

Drug therapy typically adopts acid suppression therapy with a proton pump inhibitor (PPI) along with antibiotic therapy and perhaps a bismuth containing agent such as Losec (El-Ela et al. 2019).

Tetracline

Metronidazole

Amoxicillin

Clarithromycin

Alternative clinical treatments

Acetaminophen

Surgical treatment

Cytoprotective medications

Acetaminophen (paracetamol) is not an NSAID and is therefore the preferred non-prescription treatment for pain in patients at risk for peptic ulcer disease (Chen et al. 2019).

Like a liquid bandage, these medications cover the ulcer in a protective layer to prevent further damage from digestive acids and enzymes. Sucralfate commonly recommend (Pittayanon et al. 2019).

This may be the case for ulcers that continue to return, bleed, tear through the stomach or cause obstruction. May include taking tissue from another part of the intestines and patching it over the ulcer site, tying off a bleeding artery, cutting off the nerve supply to the stomach to reduce the production of stomach acid or cauterising the ulcer (Pansa, Kurihara and Memon 2020).

prevention OF ULCERS

1.

4.

Avoid alcohol with medication

Protection from infection

Frequent hand washing and by eating foods that have been cooked completely can help reduce the spread through from saliva & food (Polfan et al. 2021).

Avoid alcohol when taking your medication, since the two can combine to increase your risk of stomach upset (Xie et al. 2020).

5.

2.

Addtional medication with NSAIDs

Avoid spicy food

If an individual requires an NSAID, one may necessitate to also take additional medications such as an antacid, a proton pump inhibitor, and an acid blocker or cytoprotective agent. A class of  NSAIDs , COX-2, inhibitors may be less likely to cause peptic ulcers, however may increase the risk of heart attack (Abdellatif et al. 2021).

Do not cause ulcers, however can may irritate an ulcer that is already there (Ratnaparikh and Adkine 2021).

3.

Avoid smoking

May increase the risk of peptic ulcers in people who are infected with H. pylori (Yu et al. 2022).

THANK YOU

FOR YOUR ATTENTION

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