Peptic Ulcer Treatment in Nagpur

Types of Peptic Ulcers

Gastric Ulcers

Gastric ulcers occur in the stomach lining and comprise 25-30% of peptic ulcer disease cases. These ulcers typically cause epigastric pain worsening with food consumption. Gastric ulcers carry higher malignancy risk than duodenal ulcers requiring careful monitoring. Acid reduction and H. pylori eradication promote rapid healing.

Duodenal Ulcers

Duodenal ulcers affect the first part of the small intestine (duodenum) and account for 70-75% of PUD cases. Pain typically occurs 2-3 hours after meals and improves temporarily with food intake. Duodenal ulcers rarely develop into cancer but recur frequently without proper treatment. H. pylori eradication prevents ulcer recurrence effectively.

Peptic Ulcer Symptoms

• Burning epigastric pain (most common symptom)

• Discomfort 2-3 hours after meals (duodenal ulcers)

• Pain immediately after eating (gastric ulcers)

• Nausea and loss of appetite

• Vomiting (sometimes blood-stained)

• Abdominal bloating and fullness

• Weight loss in severe cases

• Black tarry stools (melena) indicating bleeding

• Hematemesis (vomiting blood) in serious cases

• Sudden severe pain (perforation emergency)

Peptic Ulcer Causes

H. pylori Infection (60% of cases)

• Bacterial colonization of gastric mucosa

• Chronic inflammation causing ulceration

• Detected via breath test, stool antigen, serology, biopsy

• Eradication prevents ulcer recurrence

• Highly effective treatment available

NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) (25-30% of cases)

• Aspirin, ibuprofen, naproxen causing mucosal damage

• Inhibits protective prostaglandins

• Risk increases with age and concurrent anticoagulation

• NSAID discontinuation essential for healing

• PPI prophylaxis reduces NSAID ulcer risk

Other Causes (10-15% of cases)

• Severe stress (stress ulcers)

• Zollinger-Ellison syndrome (gastrin-secreting tumors)

• Crohn’s disease causing ileitis

• Severe liver disease

• Medications (potassium chloride, steroids)

• Rarely idiopathic without identified cause

Peptic Ulcer Diagnosis

Clinical History

• Symptom pattern and triggers

• NSAID or aspirin use

• H. pylori risk factors

• Family history of ulcer disease

Diagnostic Tests

H. pylori Testing

• Urea breath test (90% sensitivity/specificity)

• Fecal antigen testing

• Serology (antibodies indicate exposure)

• Endoscopic biopsy with rapid urease test

Endoscopy (Gastroscopy)
Visualizes ulcers directly, obtains biopsies ruling out malignancy, and assesses healing. Therapeutic endoscopy controls active bleeding through hemoclips or injection therapy.

Laboratory Assessment

• Complete blood count (assess anemia from bleeding)

• Liver function tests (exclude hepatic disease)

• Gastric pH assessment if Zollinger-Ellison suspected

Peptic Ulcer Treatment

H. pylori Eradication (Triple or Quadruple Therapy)

Triple Therapy (Standard)

• Proton pump inhibitor (omeprazole 20 mg twice daily)

• Clarithromycin 500 mg twice daily

• Amoxicillin 1000 mg twice daily

• Duration: 7-14 days

• Success rate: 85-95% eradication

Quadruple Therapy (Bismuth-Based)

• Bismuth subsalicylate 525 mg four times daily

• Proton pump inhibitor twice daily

• Tetracycline 500 mg four times daily

• Metronidazole 500 mg three times daily

• Duration: 10-14 days

• Success rate: 90-98% eradication

Acid Suppression Therapy

Proton pump inhibitors (PPIs) reduce gastric acid allowing ulcer healing:

• Omeprazole 20-40 mg daily

• Lansoprazole 30 mg daily

• Pantoprazole 40 mg daily

• Continue 4-8 weeks after eradication therapy

• Prevents recurrence when H. pylori eradicated

H2 Receptor Antagonists (Alternative)

• Ranitidine 150 mg twice daily

• Famotidine 20 mg twice daily

• Less potent than PPIs but effective

• Useful if PPI intolerance

NSAID Ulcer Management

• Discontinue NSAID if possible

• PPI co-therapy if NSAID continuation necessary

• Misoprostol 200 mcg four times daily (protective agent)

• H2 blocker alternative if PPI unavailable

Antacids

• Provide rapid symptom relief

• Neutralize existing acid only (temporary effect)

• Not suitable for long-term therapy

• Useful adjunct to acid-suppressive therapy

Lifestyle Modifications

• Avoid NSAIDs and aspirin

• Limit alcohol consumption

• Reduce stress through relaxation techniques

• Avoid smoking (impairs healing)

• Eat regular, smaller meals

• Avoid spicy foods triggering symptoms

Peptic Ulcer Complications

• Bleeding: Acute hemorrhage requiring transfusion

• Perforation: Ulcer erosion through gastric wall (emergency)

• Obstruction: Scarring narrowing pylorus obstructing food passage

• Malignancy: Gastric ulcer cancer risk (1-3%)

• Peritonitis: Infection from perforated ulcer

• Intractable ulcers: Refractory to medical therapy requiring surgery

Peptic Ulcer Prevention

• Avoid NSAIDs: Use alternative analgesics when possible

• Discontinue aspirin: Unless cardioprotective dose necessary (prophylactic PPI needed)

• H. pylori screening: Test high-risk patients

• PPI prophylaxis: If NSAID continuation necessary

• Limit alcohol: Moderate consumption only

• Smoking cessation: Critical for ulcer prevention and healing