Peptic Ulcer Disease

Peptic Ulcer Disease

1. Definition
   Peptic ulcer disease (PUD) is the formation of a mucosal defect (ulcer) in the stomach or duodenum caused by the destructive action of gastric acid and pepsin on the lining.

2. Causes / Etiology

• Infection with Helicobacter pylori (most common)
• Regular use of NSAIDs (aspirin, ibuprofen) which impair mucosal protection
• Hyper‑secretion of acid (gastrinoma, Zollinger‑Ellison)
• Severe physiological stress (burns, trauma, major surgery)
• Smoking, alcohol and genetic predisposition act as aggravating factors.

3. Types or Classification

• Gastric ulcer – ulcer located in the stomach body or antrum.
• Duodenal ulcer – ulcer situated in the first part of the small intestine.
• Stress ulcer – acute ulcer that appears in critically ill or severely stressed patients.
• NSA‑induced ulcer – ulcer that develops after prolonged intake of non‑steroidal anti‑inflammatory drugs.

4. Pathology (step‑wise)
   Step 1 → H. pylori adheres to gastric epithelium or NSAIDs damage the protective mucus →
   Step 2 → Acid‑pepsin balance tips toward aggression; mucosal injury begins →
   Step 3 → Inflammatory cells infiltrate, local blood flow falls →
   Step 4 → Erosion deepens and a true ulcer (loss of mucosa and submucosa) is formed →
   Step 5 → Healing may be incomplete, leading to chronic ulcer or scar formation.

5. Clinical Features
   General – epigastric burning or gnawing pain, nausea, occasional vomiting, loss of appetite, weight loss, early satiety.
   Specific – gastric ulcer pain usually worsens after meals and may improve with antacids; duodenal ulcer pain often appears a few hours after the last meal, is relieved by food or antacids, and may awaken the patient at night.

6. Complications
   Acute – gastrointestinal bleeding (hematemesis or melena), perforation with sudden severe abdominal pain and peritonitis.
   Chronic – gastric outlet obstruction (persistent vomiting, fullness), penetration into adjacent organs, recurrent ulceration and malignant transformation (rare in duodenal ulcer).

7. Diagnosis / Investigations

• Upper GI endoscopy (direct visualization, biopsy if needed).
• Barium meal X‑ray (shows ulcer crater, useful when endoscopy unavailable).
• Rapid urease test or histology for H. pylori on biopsy.
• Non‑invasive H. pylori tests: urea breath test, stool antigen test.
• Routine blood work: CBC (detect anemia), serum electrolytes, liver function if needed.

8. Management
   General – stop smoking and alcohol, avoid NSAIDs, give antacids for symptom relief, advise stress reduction.
   Modern treatment –
    • Proton‑pump inhibitors (omeprazole, pantoprazole) to suppress acid.
    • H2‑receptor antagonists (ranitidine, famotidine) if PPIs not available.
    • Triple therapy for H. pylori (clarithromycin + amoxicillin + PPI for 14 days).
    • Quadruple therapy (metronidazole + tetracycline + bismuth + PPI) for resistant cases.
   Dietary advice – small frequent meals, avoid very spicy or fatty foods, limit caffeine, maintain adequate hydration, include probiotic‑rich foods after eradication therapy.

9. Homeopathic Therapeutics (main remedies, key points)

Nux Vomica

• Burning epigastric pain, worse after rich food or alcohol.
• Nausea with urge to vomit, but little relief after vomiting.
• Irritable, impatient, sensitive to noise and light.
• Worse in the morning, better after coffee or brandy.
• Palpable tenderness in the epigastrium.
• Good for ulcer patients with constipation and irritability.

Lycopodium

• Bloating and flatulence, especially on the right side.
• Cramping pain that improves after passing gas.
• Appetite poor in the morning, better later in the day.
• Low confidence, fear of being alone, tendency to over‑work.
• Worse in warm rooms, better in cool fresh air.
• Useful when ulcer is associated with liver‑type dyspepsia.

Pulsatilla

• Epigastric pain that shifts location, often described as “soreness”.
• Symptoms improve with open air, worsen in warm, stuffy rooms.
• Patient is emotionally changeable, seeks consolation.
• Aversion to rich, fatty foods; prefers cold drinks.
• Often a young, thin individual with a history of “indigestion after grief”.
• Helpful when ulcer pain is relieved by lying on the left side.

Sepia

• Chronic ulcer with a feeling of heaviness in the stomach.
• Loss of appetite, especially for meat; craving for salty foods.
• Irritability towards family, desire to be alone.
• Menstrual disturbances in women (late, scanty flow).
• Worse after midnight meals, better after warm milk.
• Indicated when ulcer is accompanied by depressive mood.

Carbo V (Carbo‑vegetabilis)

• Burning pain with excessive belching and flatulence.
• Patient feels weak, wants to lie down, often has a “hollow” feeling in the abdomen.
• Symptoms aggravated by cold drinks and improve with warmth.
• Good for ulcer patients who have a history of excessive eating of vegetables or raw foods.
• Tendency to feel faint on standing, relief when lying on the back.
• Useful when ulcer is associated with a feeling of “emptiness” after meals.