What is Peptic ulcer disease (PUD) and it’s treatment ?
Peptic ulcer disease (PUD)
Group of disorders circumscribed lesions of the mucous of the upper gastrointestinal tract. lesion developed to ulcer.
Causes
- Excess acid secretion may destruction of mucous 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 peptic ulcer disease
- 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),
- Andros-copy.
Treatment of PUD
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.