CASE A 55 years old man presents with a history of worsening epigastric pain with a burning sensation, since 6 months. He notices that,the pain is worse when he is hungry. He feels nauseated with pain but is unable to vomit. He thinks he will feel better after vomiting. There is no change in his bowel habits. His weight is more or less stable. He smokes 10 cigarettes a day and drinks socially. His family Doctor had suggested him to take Ranitidine bd but that has not helped. On p/a examination: epigastric tenderness +

Differential Diagnosis of Epigastric Pain Cholelithiasis Pancreatitis Acute appendicitis PUD Malignancy GERD MI

Provisional Diagnosis DUODENAL ULCER

Peptic Ulcer Disease

 Peptic Ulcer Disease is a circumscribed ulceration or break in the lining of the gastrointestinal mucosa occurring in areas exposed to acid, most often caused by Helicobacter pylori infection.  Depending on the site, ulcers can be named as Gastric ulcer if located in the stomach & Duodenal ulcer if located in duodenum.

Peptic Ulcers: Gastric & Dudodenal

PREVALENCE Higher prevalence in developing countries Prevalence is decreasing in many Western Communities as a result of widespread use of H.pylori eradication therapy. The male to female ratio for duodenal ulcers varies from 5:1 to 2:1,whilst that for gastric ulcer is 2:1 or less.

ETIOPATHOGENESIS H Pylori NSAID’S Smoking Others- Stress, Alcohol Intake

Source : Davidsons Priciples and Practice of Medicine

CLINICAL FEATURES Abdominal pain classically epigastric strongly correlated to mealtimes.epigastric Nausea and Vomiting Hematemesis Melena

Comparing Duodenal and Gastric Ulcers

DUODENAL ULCER GASTRIC ULCER INCIDENCEMore commonLess common ANATOMYFirst part of duodenum – anterior wall Lesser curvature of stomach PAINHunger PainEating Pain MALIGNANCYRareBenign or malignant BLEEDINGMELENAHEMATEMESIS

Complications Perforation Gastric outlet obstruction Bleeding Gastric Carcinoma

INVESTIGATIONS Endoscopy Biopsy Screening for H.Pylori Urea Breath Test

MANAGEMENT H. pylori Eradication Therapy- ByPIP’s General measures :Cigarette smoking, and NSAIDs should be avoided. Surgical management.

HOMOEOPATHIC MANAGEMENT NuxVomica Carbo Veg Lycopodium Phosphorous Argentum nitricum

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