Pharmacy Clinic
Peptic Ulcer and Heart Burn
The following information must be available before considering any medication:

        Age
•        Child, adult
        Symptoms
•        Flatulence
•        Severe pain
•        Difficulty in swallowing
        Associated factors
•        Pregnancy
•        Precipitating factors
•        Weight
•        Smoking habit
        Medication
•        Medicines tried already
•        Other medicines being taken


When to seek medical help:

        Failure to respond to antiacids
        Pain radiating to arms
        Difficulty in swallowing
        Regurgitation
        Long duration
        Increase severity
        Children


Definitions:

Ulcer is an erosion of the tissue. Ulcers occur almost any where, we are familiar with many types of ulcers like ulcers
caused by viruses that some times occur in our mouth, these kinds of ulcers are usually disappear after a short period
of time, other kind of ulcer can cause mild (chronic gastritis) to severe (peptic ulcer disease)health problems.
These are types of ulcer that we are interest in (the stomach and duodenal ulcers).

The stomach and duodenal ulcers are erosions of the tissue (mucosa) which lines (forms the inner surface of) the
gastrointestinal tract.

All parts of the body exposed to the environment except the skin have this protective lining. The mucosal tissue is
primarily comprised of what are called epithelial cells, attached to what is called the basement membrane. The epithelial
mucosal cells secrete mucous so now you know why this tissue is called mucosal tissue.

Mucous is that really sticky stuff that no one really likes to talk about, but which is very protective.

Depending on where the mucosal tissue is, e.g., the respiratory, gastrointestinal, urinary, genital tracts, or the eye,
the amount of mucous and the various things secreted within this fluid, are a little different. Since we are talking about
stomach ulcers, we'll focus on the gastric mucosa.

The acidity of the stomach can be pretty high, much higher than pure lemon juice for example, which could damage
the mucosa; and protein-chewing enzyme activity could also damage these cells. However, the mucous secretions
essentially protect the cells on the inside of the stomach and duodenum from damage by acid or enzymes (for
example, bicarbonate - baking soda - ions are present which neutralize some of the effects of acid on the stomach's
inner lining; and, enzyme inhibitor substances block enzyme activity). Therefore, were the mucous secretions to stop,
the inner lining of the stomach or duodenum would be exposed to the formation of an ulcer.

Ulcer is a sore or break in the lining of the digestive tract. Most ulcers are found in the duodenum, the portion of the
small intestine just beyond the stomach. Ulcers may also form in the stomach, and these are called gastric ulcers. The
terms duodenal ulcer and gastric ulcer refers to the location of the ulcer. Peptic ulcer indicates the ulcer is due to the
damaging effects of acid and peptic, or digestive juices.

In the past it was felt that peptic ulcer disease was a chronic, recurrent disease of unknown cause. An ulcer could be
healed, but nothing could be done to alter the underlying tendency to develop ulcers.

Causes of ulcer and heartburn
                            go here........

Risk factors:
-Shock
-Multiple organ failure
-Trauma
-CNS injury

The most effective treatment for this case is the removal of illness, which the ulceration with modification in the diet
and also prophylactic drug treatment may help.

Symptoms of an Ulcer

Ulcer pain is often described as a burning sensation. It is usually located in the upper abdomen or lower chest. Typical
duodenal ulcer pain occurs 30-60 minutes after a meal and is relieved by eating again. Pain is usually worse when the
stomach is empty, and often awakens the patient from sleep.

Gastric ulcer pain generally worsens immediately with eating. Nausea, vomiting, belching, loss of appetite, bloating,
indigestion, and heartburn are other symptoms which can occur with an active ulcer. At times, an ulcer may cause no
pain at all and is only found when the patient presents with bleeding or other complications. This occurs most often in
older patients, especially if they are taking NSAID's.


Complications of Ulcer Disease

Black stools or vomiting blood indicate that the ulcer is bleeding. Severe abdominal pain may be the result of a
perforated ulcer. Either of these complications is an emergency, requiring immediate medical care.
Scarring from recurrent ulcers may narrow the lower end of the stomach or duodenum.
If this causes a blockage, surgery could be required. Many cases can be treated by stretching open the narrowed area
with a balloon.


Diagnosis

Diagnosis of H.Pylori: There are many ways used in the diagnosis of this bacterium, gastric biopsies and microbial
cultures used. “Urea Breath Test”, which is the newest one and the more expensive and complicated test which
depends on the principle that the patient feeding with C13 or C14 and collecting C13 or C14- carbon dioxide from the
breath.

This method is very sensitive method but it is not widely used and applied in the world. Other method is the detection
of IgG in the blood because this immune response increases in patients with bacteria so it should be detected in
patients not taking antibiotic because antibiotics clear bacteria and decrease IgG concentration in the blood.    
The two tests used to identify ulcers are the upper GI series and gastroscopy. The upper GI series is an x-ray done
after drinking barium to outline the stomach and duodenum.

Gastroscopy is looking inside the stomach with a lighted fiberoptic instrument. Gastroscopy is more accurate test.
Between 10 and 25% of ulcers are not seen on an upper GI series. Gastroscopy also allows diagnosis of Helicobacter
Pylori and other conditions which cannot be diagnosed by x-ray.

If an ulcer is suspected, medication is often tried before any testing is done. Patients who respond promptly may not
require any testing. If a person has weight loss, bleeding, difficulty in swallowing, or does not respond to treatment,
then gastroscopy should be performed.

Gastric ulcers pose (make) a special concern. Small, early stomach cancers can sometimes resemble an ulcer. For this
reason, most gastric ulcers should be biopsied. After 6-8 weeks of treatment, gastroscopy is repeated to be certain
the ulcer has healed. When an ulcer does not heal, it raises the suspicion of cancer, even if biopsies are negative.
Surgery may be recommended for a non healing gastric ulcer.

Treatment options.....go here....