Ulcer management

ULCER MANAGEMENT

Factors

  • Factors that play a role in peptic ulcer formation in gastric and duodenal ulcers:
    • Ulcerogenic factors include
      • acid hypersecretion
      • pepsin
      • drugs (NSAIDs, corticosteroids, ethanol, chemotherapeutic agents, cigarettes)
      • infection
      • tumors
      • stress - head trauma, shock/sepsis, emotional
      • alteration of protective factors
      • disruption of mucosal integrity and
      • decreased bicarbonate secretion
  • Symptoms of ulcers are due to a combined effect of hydrochloric acid and pepsin.
  • Acid causes pain but not tissue damage.
  • Pepsin, which is activated in acid environment, digests mucosal, muscular and vascular layers of stomach & intestines.
  • Gastric (stomach) ulcers are not due to too much acid.
  • Alkaline reflux from intestines may inflame gastric mucosa.
  • Duodenal (intestinal) ulcers are due to increased acid secretion in stomach.
  • When stomach empties into intestines there is too much acid for pancreatic secretions to neutralize and this acid erodes tissues.
  • Most common causes are H. pylori and NSAIDs as well as gastrin hypersecretion.

Goals of drug therapy for ulcers include

  • neutralize existing gastric acid - antacids
  • inhibit acid secretion - H2 antagonists, proton pump inhibitors
  • treat infection (H. pylori) - antibiotics, bismuth subsalicylate
  • protect ulcer from further damage - sucralfate
Last modified: Wednesday, 25 April 2012, 10:01 AM