Panacea Pharmacy & Medic

Peptic Ulcer Disease & Related Gastritis

 

Gastritis/ dyspepsia

What is Gastritis/ dyspepsia and how can relief from it ??

Excess production of gastric acid in stomach.  Dyspepsia as persistent abdominal pain for discomfort centred in upper abdomen.

Gastritis
Gastritis

 Causes

  • Irregular lifestyle
  • sudden  withdraw  of   gastric   suppression drugs
  • Stress
  • Zollinger Ellinson syndrome
  • Barrett oesophagus
  • Crohn’s disease.
  • Genetic factors
  • Drug-induced gastritis (eg. antibiotics,  NSAIDs ,Corticosteroid,  bisphosphonate,Calcium channel blockers, antidepressants,  iron,  nitrates,   theophyline etc.

Sign and symptoms

  • Heartburn
  • Belching
  • Water brash
  • Esophageal pain
  • Upper abdominal discomfort
  • Postprandial discomfort
  • Bloating in the upper abdomen
  • Nausea
  • Vomiting

 Treatment

  • First  choice  use antacid preparation (eg. aluminium hydroxide and magnesium hydroxide) if patient is not  a chronic renal disease patient. 
  • It should be taken 1-1.5 hours after meal .
  • Liquid dosage form is more  potent than solid doses form.
  • I suggest that Sodium Bicarbonate preparation  should avoid in hypertensive patient. Calcium carbonate and magnesium Hydroxide preparation should also be avoid.
    • If antacid can’t relieve the symptoms alone should use  H2 receptor blocker drugs (eg.  famotidine or Nizatidine.) or PPI ( eg.  esomeprazole, pantoprazole or  lansoprazole).

Dose adjustment

Nizatidine

150 mg  two times daily  for 4 weeks 30 minutes before the meal,  then once daily at night for two weeks,  if symptoms not relief extend the the treatment time for  two weeks.

Famotidine

20 mg  two times daily  for 4 weeks 30 minutes before the meal,  then once daily at night for two weeks,  if symptoms not relief extend the the treatment time for  two weeks.

PPI ( Proton Pump Inhibitor)

Esomeprazole 20 mg or prantoprazole 40 mg may be given 2  times a day  30 minutes before of meal for 3 weeks. Last 1 weeks once a day at night before the 30 minutes of meal. Dexlansoprazole is better to use 30 mg 1 or 2 times a day for 4 weeks. First 20 days  2 times a day 30 minutes before the meal and then 10 days a single dose for withdrawing the drug at night before the 30 minutes of meal.

With added a antacid preparation (eg. aluminium hydroxide and magnesium hydroxide) 1-1.5 hours after meal .

Advice

 It is very important for all gastritis,Peptic ulcer disease, duodenal ulcer disease , gastroesophageal reflux disease, gastric ulcer disease patients .

Diet

  • Patient should concern about his meal. 
  • Should be less spicy less oily . 
  • Less consume free sugar or sugar containing in food
  • Try to avoid heavy fiber food
  • Avoid  coffee
  • Alcohol
  • Avoid milk
  • Cigarette are  prohibited strongly. 

Lifestyle

  Patient  should obey the following guideline for better feel and withdrawal the medication .

Daily activities
  • Wake up at morning 6 a.m take a glass of fresh water
  • Then take100- 150 gram green papaya
  • Then take breakfast at 8 a.m.
  • At 11 a.m. take a sugar free toast biscuit with a glass of fresh water, then chewing a chewing gum for 40 to 50 minutes.
  • Take your lunch within 2 p.m. 
  • At 5 p.m. take a sugar free toast biscuit with a glass of fresh water.
  • Then chewing a chewing gum for 40 to 50 minutes.
  • Take your dinner within 8 to 9 p.m. 
  • Go to bed within 10:00 to 10:30 p.m.

Note

zollinger-ellison syndrome,  Barrett oesophagus, Genetic factors for hyposecretion may not be control in this case it is better by vagotomy or an antrectomy.

Peptic ulcer disease (PUD)

What is Peptic ulcer disease (PUD) and it’s treatment ?

Group of disorders circumscribed lesions of the mucosa of the upper gastrointestinal tract.  lesion developed to ulcer.

Peptic Ulcer
Peptic Ulcer

Causes

  • Excess acid secretion may destruction of mucosal barrier.
  • Infected by helicobacter pylori.
  • Genetic factors
  • Drug-induced gastritis (eg. antibiotics,  NSAIDs ,Corticosteroid,  bisphosphonate,Calcium channel blockers, antidepressants,  iron,  nitrates,   theophyline etc.

Sign and symptoms

  • Heartburn
  • Cramp like pain
  • Abdominal soreness
  • Hunger sensation
  • Nausea, Vomiting
  • Some time black stool
  • Occult blood in stool
  • Anemia.

Diagnosis

 It is very important to detect Helicobacter pylori infection,  about 90%  peptic ulcer disease caused by Helicobacter pylori.

Detection
  •  Use carbon 13 urea breath test, stool antigen test laboratory base anti Helicobacter pylori IgG antibodies .
  • Stool test( black stool for occult blood in stool),
  • Blood test( anemia), 
  • Androscopy. 
Treatment

 It is very important to eradicate the Helicobacter pylori.

 

Use antibiotics combination

 Clarithromycin 500 mg once daily for 7 to 10 days with amoxicillin 500 mg three times daily. 

With co-admistration  acid  suppression drugs… like H2 receptor blocker drugs (eg.  famotidine or Nizatidine.) or PPI ( eg.  esomeprazole pantoprazole or  lansoprazole) and antacid preparation.

Sucralfate
  • 1g 4 times per day 4- 8 weeks
  • Drugs  should use at least 2 hours before meal.

If if NSAID  cannot omit  with treatment  regiment,   it should better to choose alter the admistrasion route .

Dose adjustment

Nizatidine

150 mg  two times daily  for 4 weeks 30 minutes before the meal,  then once daily at night for two weeks,  if symptoms not relief extend the the treatment time for  two weeks.

Famotidine

20 mg  two times daily  for 4 weeks 30 minutes before the meal,  then once daily at night for two weeks,  if symptoms not relief extend the the treatment time for  two weeks.

PPI ( Proton Pump Inhibitor)

Esomeprazole 20 mg or prantoprazole 40 mg may be given 2  times a day  30 minutes before of meal for 3 weeks. Last 1 weeks once a day at night before the 30 minutes of meal. Dexlansoprazole is better to use 30 mg 1 or 2 times a day for 4 weeks. First 20 days  2 times a day 30 minutes before the meal and then 10 days a single dose for withdrawing the drug at night before the 30 minutes of meal.

With added a antacid preparation (eg. aluminum hydroxide and magnesium hydroxide) 1-1.5 hours after meal .

Advice

 It is very important for all gastritis,Peptic ulcer disease, duodenal ulcer disease , gastroesophageal reflux disease, gastric ulcer disease patients .

Diet

  • Patient should concern about his meal. 
  • Should be less spicy less oily . 
  • Less consume free sugar or sugar containing in food
  • Try to avoid heavy fiber food
  • Avoid  coffee
  • Alcohol
  • Avoid milk
  • Cigarette are  prohibited strongly. 

Lifestyle

  Patient  should obey the following guideline for better feel and withdrawal the medication .

Daily activities
  • Wake up at morning 6 a.m take a glass of fresh water
  • Then take100- 150 gram green papaya
  • Then take breakfast at 8 a.m.
  • At 11 a.m. take a sugar free toast biscuit with a glass of fresh water, then chewing a chewing gum for 40 to 50 minutes.
  • Take your lunch within 2 p.m. 
  • At 5 p.m. take a sugar free toast biscuit with a glass of fresh water.
  • Then chewing a chewing gum for 40 to 50 minutes.
  • Take your dinner within 8 to 9 p.m. 
  • Go to bed within 10:00 to 10:30 p.m.

Duodenal ulcer

Ulcer develop in the duodenal bulb or between the bulb and the ampulla.

duodenal-ulcer
duodenal-ulcer
Causes
  • Excess acid secretion may destruction of mucosal barrier.
  • Infected by Helicobacter pylori.
  • Genetic factors
  • Drug-induced gastritis (eg. antibiotics,  NSAIDs ,Corticosteroid,  bisphosphonate,Calcium channel blockers, antidepressants,  iron,  nitrates,   theophyline etc.
Sign and symptoms
  • Pain in epigastric area
  • Pain radiate below the costal margins into the back for the right solder
  • Food  may relief pain 
  • Weight  gain
  • Heartburn, cramp like pain abdominal soreness
  • Hunger sensation
  • Nausea, vomiting
  • Some time black stool, occult blood in stool
  • Anemia.
Diagnosis
  • Serum pepsinogen 1 should measure
  • Dodenal ulcer patient   pepsinogen1 and gastrin hormone elevated in serum.

 It is very important to detect helicobacter pylori infection,  about 60%  peptic ulcer disease caused by helicobacter pylori.

Detection
  • Use carbon 13 urea breath test, stool antigen test laboratory base anti helicobacter pylori IgG antibodies .
  • Stool test( black stool for occult blood in stool),
  • Blood test( anaemia)
  • Androscopy. 
Treatment

Treatment by medicin is similar like PUD. It is very important to eradicate the Helicobacter pylori at first.

 

Use antibiotics combination

 Clarithromycin 500 mg once daily for 7 to 10 days with amoxicillin 500 mg three times daily. 

With co-admistration  acid  suppression drugs… like H2 receptor blocker drugs (eg.  famotidine or Nizatidine.) or PPI ( eg.  esomeprazole pantoprazole or  lansoprazole) and antacid preparetion.

Sucralfate
  • 1g 4 times per day 4- 8 weeks
  • Drugs  should use at least 2 hours before meal.

If if NSAID  cannot omite  with treatment  regiment,   it should better to choose alter the admistrasion route .

Dose adjustment

Nizatidine

150 mg  two times daily  for 4 weeks 30 minutes before the meal,  then once daily at night for two weeks,  if symptoms not relief extend the the treatment time for  two weeks.

Famotidine

20 mg  two times daily  for 4 weeks 30 minutes before the meal,  then once daily at night for two weeks,  if symptoms not relief extend the the treatment time for  two weeks.

PPI ( Proton Pump Inhibitor)

Esomeprazole 20 mg or prantoprazole 40 mg may be given 2  times a day  30 minutes before of meal for 3 weeks. Last 1 weeks once a day at night before the 30 minutes of meal. Dexlansoprazole is better to use 30 mg 1 or 2 times a day for 4 weeks. First 20 days  2 times a day 30 minutes before the meal and then 10 days a single dose for withdrawing the drug at night before the 30 minutes of meal.

With added a antacid preparation (eg. aluminium hydroxide and magnesium hydroxide) 1-1.5 hours after meal .

Advice

 It is very important for all gastritis,Peptic ulcer disease, duodenal ulcer disease , gastroesophageal reflux disease, gastric ulcer disease patients .

Diet

  • Patient should concern about his meal. 
  • Should be less spicy less oily . 
  • Less consume free sugar or sugar containig in food
  • Try to avoid heavy fibre food
  • Avoid  coffee
  • Alcohol
  • Avoid milk
  • Cigarette are  prohibited strongly. 

Lifestyle

  Patient  should obey the following guideline for better feel and withdrawal the medication .

Daily activities
  • Wake up at morning 6 a.m take a glass of fresh water
  • Then take100- 150 gram green papaya
  • Then take breakfast at 8 a.m.
  • At 11 a.m. take a sugar free toast biscuit with a glass of fresh water, then chewing a chewing gum for 40 to 50 minutes.
  • Take your lunch within 2 p.m. 
  • At 5 p.m. take a sugar free toast biscuit with a glass of fresh water.
  • Then chewing a chewing gum for 40 to 50 minutes.
  • Take your dinner within 8 to 9 p.m. 
  • Go to bed within 10:00 to 10:30 p.m.

Gastric ulcer

Ulcer most commonly in the antrum or at the antral-fundal Junction.

Gastric ulcer
Gastric ulcer

Causes

  • Deficient gastric mucosal barrier
  • It may be infected by helicobacter pylori
  • Excessive use of NSAID, Steroid  or other relative use or drug.

Sign and symptoms

  • Pain- it is less localised
  • Pain in in left subcostal region
  • Nactural pain
  • Food intake  may induce the pain
  • Weight loss.

Diagnosis

  • Elevated serum gastrin levels
  • Androscopy
  • Helicobacter pylori test 
Treatment

Treatment by medicine is similar like PUD. It is very important to eradicate the Helicobacter pylori at first.

 

Use antibiotics combination

 Clarithromycin 500 mg once daily for 7 to 10 days with amoxicillin 500 mg three times daily. 

With co-admistration  acid  suppression drugs… like H2 receptor blocker drugs (eg.  famotidine or Nizatidine.) or PPI ( eg.  esomeprazole pantoprazole or  lansoprazole) and antacid preparetion.

Sucralfate
  • 1g 4 times per day 4- 8 weeks
  • Drugs  should use at least 2 hours before meal.

If if NSAID  cannot omite  with treatment  regiment,   it should better to choose alter the admistrasion route .

Dose adjustment

Nizatidine

150 mg  two times daily  for 4 weeks 30 minutes before the meal,  then once daily at night for two weeks,  if symptoms not relief extend the the treatment time for  two weeks.

Famotidine

20 mg  two times daily  for 4 weeks 30 minutes before the meal,  then once daily at night for two weeks,  if symptoms not relief extend the the treatment time for  two weeks.

PPI ( Proton Pump Inhibitor)

Esomeprazole 20 mg or prantoprazole 40 mg may be given 2  times a day  30 minutes before of meal for 3 weeks. Last 1 weeks once a day at night before the 30 minutes of meal. Dexlansoprazole is better to use 30 mg 1 or 2 times a day for 4 weeks. First 20 days  2 times a day 30 minutes before the meal and then 10 days a single dose for withdrawing the drug at night before the 30 minutes of meal.

With added a antacid preparation (eg. aluminium hydroxide and magnesium hydroxide) 1-1.5 hours after meal .

Advice

 It is very important for all gastritis,Peptic ulcer disease, duodenal ulcer disease , gastroesophageal reflux disease, gastric ulcer disease patients .

Diet

  • Patient should concern about his meal. 
  • Should be less spicy less oily . 
  • Less consume free sugar or sugar containig in food
  • Try to avoid heavy fibre food
  • Avoid  coffee
  • Alcohol
  • Avoid milk
  • Cigarette are  prohibited strongly. 

Lifestyle

  Patient  should obey the following guideline for better feel and withdrawal the medication .

Daily activities
  • Wake up at morning 6 a.m take a glass of fresh water
  • Then take100- 150 gram green papaya
  • Then take breakfast at 8 a.m.
  • At 11 a.m. take a sugar free toast biscuit with a glass of fresh water, then chewing a chewing gum for 40 to 50 minutes.
  • Take your lunch within 2 p.m. 
  • At 5 p.m. take a sugar free toast biscuit with a glass of fresh water.
  • Then chewing a chewing gum for 40 to 50 minutes.
  • Take your dinner within 8 to 9 p.m. 
  • Go to bed within 10:00 to 10:30 p.m.

Gastro-oesophageal Reflux disease(GORD)

Retrograde movement of gastric contents from the stomach into the  esophagus. when reflux  leads to to inflamation (with or without eration or ulceration)  of the esophagus as it is called Reflux esophagitis.

GORD
GORD

Causes

  • Transient lower esophageal sphincter relaxation (TLESR).
  • Increase abdominal pressure due to LES pressure
  • Abdominal motility problem that reflux of acid and other noxious substances,  when  noxious substances in the refluxate are in contact with the  esophageal  mucosa long enough to cause irritation and inflammation. 
  • Sudden  withdraw  of   gastric   suppression drugs
  • Stress
  • Zollinger Ellinson syndrome
  • Barrett oesophagus
  • Crohn’s disease.
  • Genetic factors
  • Drug-induced gastritis (eg. antibiotics,  NSAIDs ,Corticosteroid,  bisphosphonate,Calcium channel blockers, antidepressants,  iron,  nitrates,   theophyline etc.

Sign and symptoms

  • Heartburn
  • Belching
  • Regurgitation
  • Water brash
  • Chest pain,
  • Pain radiate to the neck 
  • Hoarseness
  • Loss of dental enamel
  • Asthma
  • Chronic cough

Diagnosis

  • Androscopy
  • Adenocarcinoma test 
  • Barrett oesophagus

Treatment

  • First  choice  use antacid preparation (eg. aluminium hydroxide and magnesium hydroxide) if patient is not  a chronic renal disease patient. 
  • It should be taken 1-1.5 hours after meal .
  • Liquid dosage form is more  potent than solid doses form.
  • I suggest that Sodium Bicarbonate preparation  should avoid in hypertensive patient. Calcium carbonate and magnesium Hydroxide preparation should also be avoid.
    • If antacid can’t relieve the symptoms alone should use  H2 receptor blocker drugs (eg.  famotidine or Nizatidine.) or PPI ( eg.  esomeprazole, pantoprazole or  lansoprazole).

Dose adjustment

Nizatidine

150 mg  two times daily  for 4 weeks 30 minutes before the meal,  then once daily at night for two weeks,  if symptoms not relief extend the the treatment time for  two weeks.

Famotidine

20 mg  two times daily  for 4 weeks 30 minutes before the meal,  then once daily at night for two weeks,  if symptoms not relief extend the the treatment time for  two weeks.

PPI ( Proton Pump Inhibitor)

Esomeprazole 20 mg or prantoprazole 40 mg may be given 2  times a day  30 minutes before of meal for 3 weeks. Last 1 weeks once a day at night before the 30 minutes of meal. Dexlansoprazole is better to use 30 mg 1 or 2 times a day for 4 weeks. First 20 days  2 times a day 30 minutes before the meal and then 10 days a single dose for withdrawing the drug at night before the 30 minutes of meal.

With added a antacid preparation (eg. aluminium hydroxide and magnesium hydroxide) 1-1.5 hours after meal .

Advice

 It is very important for all gastritis,Peptic ulcer disease, duodenal ulcer disease , gastroesophageal reflux disease, gastric ulcer disease patients .

Diet

  • Patient should concern about his meal. 
  • Should be less spicy less oily . 
  • Less consume free sugar or sugar containig in food
  • Try to avoid heavy fibre food
  • Avoid  coffee
  • Alcohol
  • Avoid milk
  • Cigarette are  prohibited strongly. 

Lifestyle

  Patient  should obey the following guideline for better feel and withdrawal the medication .

Daily activities
  • Wake up at morning 6 a.m take a glass of fresh water
  • Then take100- 150 gram green papaya
  • Then take breakfast at 8 a.m.
  • At 11 a.m. take a sugar free toast biscuit with a glass of fresh water, then chewing a chewing gum for 40 to 50 minutes.
  • Take your lunch within 2 p.m. 
  • At 5 p.m. take a sugar free toast biscuit with a glass of fresh water.
  • Then chewing a chewing gum for 40 to 50 minutes.
  • Take your dinner within 8 to 9 p.m. 
  • Go to bed within 10:00 to 10:30 p.m.

Note: If sprinter become more deform please go to surgery.

How can withdraw gastric acid suppresses medicine??

Gastritis is a common issue for every person but many of the people suffering by it for extreme level. Some of people become use to by various gastric acids suppresses medicine and can’t omit this type of medicine use. These type of medicine are PPI drugs (Esomeprazole, prantoprazole, Dexlansoprazole, Omeprazole etc.) or H2 receptor blocker drugs (Famotidine, Nizatidine etc )

 When they try to omit this medicine use gastric acid secretion increases more. Ultimately they can’t omit the medicine use.

If anyone can omit to use gastric acid suppresses medicine they should take the following guidelines.

For withdrawing gastric acid suppresses medicine I suggest to obey some following steps strictly.

Step 1st

Specifically calculation your everyday gastric acid suppresses medicine that you use. Suppose you take Esomeprazole 40 mg (any PPI) at morning and Esomeprazole 40 mg at evening.  Now you should change your evening dose as half like Esomeprazole 20 mg and unchanged your morning dose and continue it for 7 days. If you don’t feel any complication you should go for 2nd step.

Step 2nd

Now you should change your morning dose as half like Esomeprazole 20 mg and unchanged your evening dose and continue it for 7 days. If you don’t feel any complication you should go for 3rd step.

 

Step 3rd

Now you should change your evening dose and medicine as like Famotidine 20 mg (H2 receptor blocker) and unchanged your morning dose and continue it for 7 days. If you don’t feel any complication you should go for 4th step.

Step 4th

Now you should change your morning dose and medicine as like Famotidine 20 mg (H2 receptor blocker) and unchanged your evening dose and continue it for 7 days. If you don’t feel any complication you should go for 5th step.

Step 5th

Now you should only continue your evening dose and medicine as like Famotidine 20 mg (H2 receptor blocker) and omit your morning dose and continue it for 7 days. If you don’t feel any complication you should go for 6th step.

6th step

After 7 days you can omit your last evening dose. If you faced  any gastritis problem sometime you should take any antacid preparation

1-1.5 hours after meal.

Note: All types PPI drugs (Esomeprazole, prantoprazole, Dexlansoprazole, Omeprazole etc.) or H2 receptor blocker drugs (Famotidine, Nizatidine etc ) should take 30 minutes before meal.

If you use to by Esomeprazole 20 mg or any other PPI you should Start from step 3rd and If you use to by Famotidine 20 mg or any other H2 receptor blocker drugs you should start from step 4th .