PEPTIC ULCER &

LIBRAX

Presented by:IMRAN SHAFIQ MALIK

What is an ulcer?

An ulcer is a sore in the lining of the stomach or

duodenum (the first part of the small intestine). People of any age can acquire an

ulcer. Women are affected just as often as men.

What causes Peptic ulcers?

Doctors used to think Peptic ulcers were caused by stress

or by eating food with too much acid in it. We now know this isn’t true. It is caused by an infection . This infection is caused by a bacteria (germ) called Helicobacter pylori or

H. pylori.

Helicobacter pyloriBacteria That Cause Ulcers

live organism 3D morphology www.cellsalive.com

biology.kenyon.edu/.../ helicobacter/htm

Helicobacter is a Gram-negative, spiral shaped organism with flagella. It has a potent multisubunit urease enzyme that enables it

to survive in acidic pH conditions and colonize the gastric environment (TIGR, 2004). H. pylori utilizes the enzyme urease to

convert urea into bicarbonate and ammonia to combat the low acidity of the stomach. The mixing of the two extreme pH levels

creates a neutralized protective cloud around the H. pylori, allowing it to survive in the stomach (Helicobacter Foundation, 2004)

HISTORY of UlcerEarly 20th Century Ulcers are believed to be caused by stress and dietary factors. Treatment focuses on hospitalization, bed rest, and prescription of special bland foods. Later, gastric acid is blamed percent receive antibiotic therapy. Consumer for ulcer disease. Antacids and medications that block acid production become the standard of therapy. Despite this treatment, there is a high recurrence of ulcers.

1982 Australian physicians Robin Warren and Barry Marshall first identify the link between Helicobacter pylori (H. pylori) and ulcers, concluding that the bacterium, not stress or diet, causes ulcers. The medical community is slow to accept their findings.

1994 A National Institutes of Health Consensus Development Conference concludes that there is a strong association between H. pylori and ulcer disease, and recommends that ulcer patients with H. pylori infection be treated with antibiotics.

1995 Data show that about 75 percent of ulcer patients are still treated primarily with antisecretory medications, and only 5 research by the American Digestive Health Foundation finds that nearly 90 percent of ulcer sufferers are unaware that H. pylori causes ulcers. In fact, nearly 90 percent of those with ulcers blame their ulcers on stress or worry, and 60 percent point to diet.

1996The Food and Drug Administration approves the first antibiotic for treatment of ulcer disease.

1997 (CDC), with other government agencies, academic institutions, and industry, launches a national education campaign to inform health care providers and consumers about the link between H. pylori and ulcers. This campaign reinforces the news that ulcers are a curable infection, and the fact that health can be greatly improved and money saved by disseminating information about H. pylori. Medical researchers sequence the H. pylori genome. This discovery can help scientists better understand the bacterium and design more effective drugs to fight it.

http://www.faseb.org/opa/pylori/pylori.html

Expected costs and days of treatment for ulcer therapy under three different protocols

http://www.safewater.org/facts/helicobacter.html

 

Map showing percentages of population infected with H. pylori as

determined by epidemiological studies.

http://www.faseb.org/opa/pylori/pylori.html

Symptoms

Abdominal painNauseaVomiting (with or without blood)Unintentional weight lossChest painBloody stoolsFatigue

Transmission

Fecal-oral

Cat feces on the hands

Contaminated well water

Infected object

Diagnosis

Upper GI series of X-rays after injection of barium

Endoscopy

Specimen from stomach

Laboratory technicians gram-stain smears of specimen

Positive urease

Serological Test

biology.kenyon.edu/.../ helicobacter/htm

Several Methods Used to DiagnoseH. pyloriSerological tests

Measures specific H. pylori IgG antibodies can determine if a person has been infected

Breath test The patient is given either 13C- or 14C-labeled urea to drink. H. pylori metabolizes the urea rapidly, and the labeled carbon is absorbed. This labeled carbon can then be measured as CO2 in the patient's expired breath to determine whether H. pylori is present. The sensitivity and specificity of the breath test ranges from 94% to 98%. Upper esophagogastroduodenal endoscopy is considered the reference method of diagnosis. During endoscopy, biopsy specimens of the stomach and duodenum are obtained and the diagnosis of H. pylori can be made by several methods: The biopsy urease test - a colorimetric test based on the ability of H. pylori to produce urease; it provides rapid testing at the time of biopsy. Histologic identification of organisms - considered the gold standard of diagnostic tests. Culture of biopsy specimens for H. pylori, which requires an experienced laboratory and is necessary when antimicrobial susceptibility testing is desired

Treatment

Peptic ulcer are usually treated with a combination

of antibiotics, acid suppressors and stomach protectors. Drugs used to

treat ulcers include:-antibiotics-antacids

Treatment regimens which have been repeatedly shown to be effective in

eradicating H. pylori Length of treatment Component drugs (days) Regimens based on clarithromycin

14 Ranitidine Clarithromycin 500 mg bismuth citrate twice daily 400 mg twice daily7-10 Ranitidine bismuth citrate Amoxicillin Clarithromycin 400 mg twice daily 1000 mg twice daily 500 mg twice daily7-10 Proton pump inhibitor Amoxicillin 1000 mg Clarithromycin twice daily twice daily 500 mg twice daily Regimens based on metronidazole (or tinidazole)14 Bismuth compound Tetracycline 500 mg Metronidazole 4 times/day 4 times/day 400-500 mg 3-

4 times/day

7-10 Proton pump inhibitor Amoxicillin 500 mg Metronidazole twice daily 2-3 times/day 400-500 mg 2-

3 times/day4-7 Proton pump Colloidal Tetracycline Metronidazole 400-

inhibitor twice daily bismuth 500 mg 500mg 3-4times/daily

subcitrate 4 times/daily 4 times/day     Regimens based on clarithromycin plus metronidazole (or tinidazole)7 Ranitidine bismuth Clarithromycin 500 mg Metronidazole 400-500 mg citrate 400 mg twice daily twice daily twice daily

7 Proton pump inhibitor Clarithromycin 500 mg Metronidazole 400-500 mg twice daily twice daily twice daily twice daily

References:

http://bmj.bmjjournals.com/cgi/content/full/320/7226/31/T1

http://www.cdc.gov/ulcer

http://digestive.niddk.nih.gov/ddiseases/pubs/hpylori

http://www.cdc.gov/ulcer/history.htm

http://www.familydoctor.org/271.xml

Buaman, Robert W. Microbiology Alternate Edition with Disease by Body System