N72: Peptic Ulcer Disease

1
N72 Peptic Ulcer Disease

• By
• Susan Appel RN MN CCRN CS
• July 2001

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Definition

• The term peptic ulcer disease (PUD) refers to a
  a group of upper GI disorders, characterized by
  varying degrees of erosion of the gut wall.

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Prevalence of PUD

• 10 of Americans have PUD
• 4.5 new cases per year
• Now known to be most commonly caused by an
  infection with Helicobacter pylori.

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The Most Common causes of PUD in order are

• Helicobacter Pylori
• NSAIDs
• Hypersecretion of Acid
  Zollinger-Ellison Syndrome

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Pathogenesis of Peptic Ulcers

• Develops when there is an imbalance between
  mucosal defensive factors and aggressive factors
• See fig 73-1 p. 848 Lehne

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An Imbalance between Defensive Aggressive
Factors leads to PUD

• Defensive Factors
• Mucus
• Bicarbonate
• Blood Flow
• Postaglandins

• Aggressive Factors
• Helicobacter Pylori
• NSAIDs
• Gastric Acid
• Pepsin
• Smoking

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Test for H-Pylori

• Invasive Biopsy
• Non-invasive
• Breath Test
• Serologic

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Overview of Treatment

• Drug Therapy
• Antibiotics
• Antisecretory agents H2 Blockers Proton Pump
  Inhibitors
• Mucosal Protection
• Antisecretory agents Cytotec
• Antiacids

• Avoidance of Risk Factors
• NSAIDs
• Smoking
• Eat Pattern/ Diet
• Alcohol if exacerbation occurs

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Specific Treatments for H-pylori

• American College of Gastroenterology recommended
  in 1998 the use of at least two antibiotics to
  miminize resistance.
• Use of H2RA and PPI
• 14-day course of treatment
• See table 73-2 p. 851 Lehne

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Antisecretory Agents

• Histamine Receptor Blockers H2
  Blockers
• Tagamet
• Pepcid
• Zantac
• Over the counter (OTC) in low doses

• Proton Pump Inhibitor
• Prevacid
• Prilosec
• Most effective for suppression gastric acid
  secreation
• New therefore still high cost

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Management of other Upper GI Disorders

• Gastro esophageal Reflux Disease (GERD)
• Zollinger-Ellison Syndrome
• Duodenal Ulcers
• Aspiration Pneumonitis
• Heart Burn, Indigestion and/ or Sour Stomach

• Tagment is the drug of choice (DOC)
• Interactions occur with coumadin, phenytoin,
  theophylline, and lidocaine
• Their dosages should be reduced

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Other Ulcer Medications

• Carafate promotes healing of ulcers, forms
  protetective barrier
• Misoprostol (Cytotec) only approved for
  preventing NSAIDs induced ulcers.
• Antacids neutralizes stonmach acid, use for PUD
  GERD.