Peptic Ulcer Disease
Learning Outcomes
[Link] peptic ulcer disease,
gastroesophageal reflux disease and
Zollinger-Ellison syndrome.
[Link] the signs and symptoms of each
disease.
[Link] the different ways on how to treat or
prevent such disease.
Topic Outline
01 02 03
Peptic Ulcer Gastroesophageal Zollinger-Ellison
Disease Reflux Disease Syndrome
What is Peptic
Ulcer Disease ?
Also known as PUD
Peptic Ulcer Disease
Peptic ulcer disease (PUD) is
characterized by discontinuation in the
inner lining of the gastrointestinal (GI)
tract because of gastric acid secretion
or pepsin. It usually occurs in the
stomach and proximal duodenum.
NSAIDs
Causes of
Peptic ulcer
Medication Disease
H. pylori infection
Peptic Ulcer due to [Link] infection
● Eradication of [Link] speeds up healing of
ulcers, but the major benefit is in reduction
of recurrence and avoidance of the need
for long-term acid-suppression therapy.
● Antibiotics alone, or acid-suppressing
agents alone, do not eradicate [Link].
Peptic Ulcer due to [Link] infection
● Both therapies need to act
synergistically (should be combined)
because growth of the microorganism
occurs at elevated pH, and antibiotics
efficacy is enhanced during growth.
Peptic Ulcer Disease
Symptoms
❑ Abdominal discomfort or pain
❑ Pain radiating to the back (which could indicate the
ulcer has penetrated)
❑ Burning or gnawing feeling similar to hunger pains
❑ Pain aggravated by meals (may suggest gastric ulcers)
❑ Pain relieved by meals (may suggest duodenal ulcers)
Drugs for Treatment
Omeprazole (Prilosec) Test Urgent
Lansoprazole (Prevacid)
Rabeprazole (Aciphex)
Esomeprazole (Nexium)
Pantoprazole (Protonix)
Prevention/Treatment
1. Not drinking more than
two alcoholic beverages a
day
2. Not mixing alcohol with
medication.
3. Washing your hands
frequently to avoid
infection.
4. Limiting your use of
ibuprofen, aspirin, and
naproxen.
Prevention/Treatment
.
Medications that block
❑
acid production and
promote healing.
❑ Medications to reduce
acid production.
❑ Antacids that neutralize
stomach acid.
❑ Antibiotic medications to
kill H. pylori.
Gastroesophageal
Reflux Disease
What is
Gastroesophageal
Reflux
Disease?
Gastroesophageal Reflux
Disease
It is a chronic condition in which acid
flows back into the esophagus, causing
irritation and inflammation of the lining
of esophagus.
Causes of Gastroesophageal Reflux
Disease
caused by frequent
acid reflux
reflux of nonacidic
content from the
stomach
Gastroesophageal reflux
disease Symptoms
Drugs for Treatment of GERD
esomeprazole (Nexium) Test Urgent
lansoprazole (Prevacid)
rabeprazole (Aciphex)
esomeprazole (Nexium)
dexlansoprazole
(Dexilant)
pantoprazole (Protonix)
Prevention/Treatment
➢ Avoid foods that slow gastric
emptying, including fatty foods.
➢ Do not lie down immediately
after a meal.
➢ Avoid foods that increase the
level of acid in your stomach,
including caffeinated beverages.
➢ Lifestyle and dietary changes
➢ Medication
➢ Endoscopic therapy
➢ Surgery
Zollinger-Ellison
Syndrome
What is Zollinger-
Ellison
Syndrome?
Zollinger-Ellison
Syndrome
a rare condition in which one or more tumors grow
in the pancreas or in the upper part of the small
intestine. The tumors are called these gastrinomas.
These gastrinomas produce large amounts of the
hormone gastrin. Gastrin causes the stomach to
produce too much acid, which leads to peptic ulcers.
What causes Zollinger-
Ellison syndrome?
ZES is caused by tumors
called gastrinomas. The
tumors cause the release
of too much stomach acid.
The extra acid can cause
painful peptic ulcers
inside the lining of your
stomach and intestines.
Zollinger-Ellison
Syndrome Symptoms
• Stomach pain.
• Diarrhea.
• Burning, aching or discomfort in your upper
abdomen.
• Acid reflux and heartburn.
• Burping.
• Nausea and vomiting.
• Bleeding in your digestive tract.
Drugs for Treatment of ZES
esomeprazole (Nexium) Test Urgent
lansoprazole (Prevacid)
rabeprazole (Aciphex)
esomeprazole (Nexium)
pantoprazole
(Protonix)
Prevention/Treatment
Medicines known as proton pump
inhibitors are the first line of
treatment. These are effective
medicines for controlling acid
production in Zollinger-Ellison
syndrome. Proton pump inhibitors are
powerful acid-reducing medicines.
They work by blocking the action of
the tiny "pumps" within acid-secreting
cells.
Inflammatory
Bowel Disease,
Constipation &
Diarrhea
LEARNING OUTCOMES
At the end of the discussion, students are expected to:
Understand the difference between Inflammatory Bowel
1.
Disease, Constipation, and Diarrhea.
2. Identify their causes and symptoms.
3. Know the proper drugs for each condition.
Inflammatory
Bowel Disease
Conditions Involving Digestion
What is Inflammatory
Bowel Disease (IBD)?
Is a term for two conditions (Crohn’s
disease and ulcerative colitis) that are
characterized by chronic inflammation of
the gastrointestinal (GI) tract.
Main Types of IBD
Crohn’s Disease Ulcerative Colitis
• From the mouth to the anus
Affected Location • Often affects the portion of the Occurs in the large intestine
small intestine before the large (colon) and the rectum.
intestine/colon.
Patches that are next to areas Starting at the rectum and
Damaged Areas
of healthy tissue. spreading further into the colon.
Multiple layers of the walls of Innermost layer of the lining of
Inflammation the GI tract. the colon.
Common Symptoms of IBD
Persitent Diarrhea Weight loss
Includes persistent Loss of appetite
infection
Abdominal Paiin Rectal Bleeding
Digestion issues It could be a sign of
something serious
Fatigue
A feeling of constant
tiredness or weakness
Possible Causes of IBD
✓ The immune system responds ✓ There also appears to be a
incorrectly to environmental genetic component. Someone
triggers, such as a virus or with a family history of IBD is
bacteria, which causes more likely to develop this
inflammation of the inappropriate immune
gastrointestinal tract. response.
Common Medications
5-aminosalicylic acids Biologics
• Balsalazide (Colazal and Giazo) • Remicade® (infliximab)
• Olsalazine (Dipentum) • Humira® (adalimumab)
• Sulfasalazine (Azulfidine EN-tabs • Simponi® (golimumab)
and Azulfidine tablets) • Cimzia® (certolizumab pegol)
Common Medications
Corticosteroids Immuno-modulators
• Cortisone • Thalidomide (Thalomid)
• Hydrocortisone • Lenalidomide (Revlimid)
• Prednisone • Pomalidomide (Pomalyst)
Constipation
Conditions Involving Digestion
What is
Constipation?
Constipation is infrequent and
unsatisfactory defecation fewer than
three times per week.
HOW DOES
CONSTIPATION
HAPPEN?
Constipation occurs because your colon
absorbs much water from waste and dries
out the stool, making it hard in texture
and challenging to move out of the body.
Primary Constipation
Primary constipation is also called
“idiopathic” or “functional”
constipation.
Secondary Constipation
Secondary constipation is constipation that
occurs as a result of an underlying health
issue or a side effect of medication use.
TYPES OF
PRIMARY
CONSTIPATION
Normal Transit Constipation:
People with normal transit constipation may
experience abdominal pain and bloat.
Slow Transit Constipation:
The food moves through the digestive tract
more slowly than expected, and stools take
extended to pass through the colon.
Outlet Constipation:
In this type of constipation, damage to the
pelvic floor muscles or nerves makes it
challenging for an individual to pass stools.
Common Symptoms and Signs of Constipation
● Passing fewer than three stools a week.
● Hard and dry stools that may be painful to
pass
● Straining to have bowel movements.
● Difficulty in passing the stool.
● Stomach ache or cramps.
● Bloated abdomen.
● The sensation afterward that the bowel
hasn’t fully emptied.
● Abdominal cramps.
● Having to sit on the toilet for a long time.
CONSTIPATION DRUGS
Fiber supplements Stimulants
• Calcium polycarbophil (FiberCon) • Bisacodyl (Correctol, Dulcolax)
• Methylcellulose fiber (Citrucel) • Sennosides (Senokot, Ex-Lax,
• Psyllium (Konsyl, Metamucil) Perdiem)
• Wheat dextrin (Benefiber)
Osmotics
• Oral magnesium hydroxide (Phillips' Milk of
Magnesia
• Dulcolax Milk of Magnesia
• Magnesium citrate
• Lactulose (Cholac, Constilac)
• Polyethylene glycol (Miralax, Glycolax)
CONSTIPATION DRUGS
Lubricants Stool Softeners
Enemas and Suppositories
• Milk of Magnesia • Dulcolax (Laxative) • Docusate sodium
• Miralax • Glycerin • Docusate calcium (Surfak)
• Sorbitol • Bisacodyl
Diarrhea
Conditions Involving Digestion
What is Diarrhea?
Diarrhea is loose, watery stools three or more
times a day. Diarrhea may be acute, persistent, or
chronic:
● Acute diarrhea is a common problem that
typically lasts 1 or 2 days and goes away on
its own.
● Persistent diarrhea lasts longer than 2
weeks and less than 4 weeks.
● Chronic diarrhea lasts at least 4 weeks.
Chronic diarrhea symptoms may be
continual or may come and go
CAUSES OF DIARRHEA
01 02 03
Viruses Bacteria & Parasites Medications
Rotavirus is a common cause Exposure to pathogenic Many medications, such as
of acute childhood diarrhea. bacteria, such as E. coli. antibiotics, can cause
diarrhea.
04 05 06
Lactose Intolerance Fructose Artificial Sweeteners
People who have difficulty Fructose can lead to diarrhea Sorbitol, erythritol and
digesting lactose have in people who have trouble mannitol— can cause
diarrhea after eating dairy digesting it. diarrhea in some otherwise
products. healthy people.
Complications of Diarrhea
DEHYDRATION
●The body lacks enough fluid and electrolytes to
work properly. Body loses more fluid and
electrolytes in loose stools than solid stools. See
a list of the symptoms of dehydration.
MALABSORPTION
If people do not absorb enough nutrients from
the food they eat, they may become
malnourished.
Symptoms of Diarrhea
▪ An urgent need to use the ▪ Pain in the abdomen
bathroom ▪ Bloody stools
▪ Cramping ▪ Fever and chills
▪ Loss of control of bowel ▪ Light-headedness and
movements dizziness
▪ Nausea ▪ Vomiting
SYMPTOMS:
Dehydration and Malabsorption
Dehydration Malabsorption
● Thirst ● Bloating
● Urinating less than usual ● Changes in appetite
● Feeling tired ● Gas
● Dark-colored urine ● Loose, greasy, foul-smelling bowel
● Dry mouth movements
● Decreased skin turgor ● Weight loss
● Sunken eyes or cheeks
● Light-headedness or fainting
Medications For Diarrhea
Over the Counter (OTC)
Drugs Prescription Drugs
• Loperamide • Alosetron
• Bismuth subsalicylate • Eluxadoline
• Rifaximin
GASTROINTESTINAL
INFECTIONS
- are viral, bacterial or parasitic infections
that cause gastroenteritis, an inflammation
of the gastrointestinal tract involving both
the stomach and the small intestine.
WHAT CAUSES
IT?
● Dehydration is the main danger of
gastrointestinal infections, so
hydration is important
Gastrointestinal infections can be caused by a large
number of microorganisms, including:
Rotavirus - (stomach flu)most frequent cause of
diarrhea in young children and infants
Salmonella and Shigella - food-borne GI
illnesses
Escherichia coli, often called E. coli - is the
leading cause of travelers’ diarrhea and a major
cause of diarrheal disease in the developing
world, especially among children
Helicobacter pylori - is a cause of gastritis and
is associated with the development
of gastric and duodenal ulcers.
Staphylococcus aureus - is the most common cause of food
intoxication, characterized by abrupt/violent onset, severe nausea,
cramps, vomiting, and diarrhea using lasting 1-2 days
Yersinia enterocolitica, called Y. enterocolitica -
is a relatively infrequent cause of diarrhea and
abdominal pain. Infection is most often acquired by
eating contaminated food, especially raw or
undercooked pork products, as well as ice-cream
and milk
SIGNS &
SYMPTOMS
• Nausea
• Vomiting
• Stomach cramps and pain
• Muscle aches
• Headache
• Low-grade fever
• Watery, usually nonbloody
diarrhea
• Co-trimoxazole and metronidazole
• Azithromycin
• Rifaximin
• Ceftriaxone
• Metronidazole
• Ciprofloxacin
• Ampicillin
• Trimethoprim-sulfamethoxazole
PREVENTION/TREATMENT
The best ways to prevent gastrointestinal infection
include:
• Proper hand-washing
• Disinfecting of contaminated surfaces with bleach
• Washing of soiled articles of clothing
• Rehydration
• Antibiotics – not usually recommended as they have no
effect – causes side effects – overuse increases the
risk of resistant bacteria developing
• Antibiotics – severe cases