Peptic ulcer disease

Clinic

• PUD is a break in the inner lining of the stomach, the first part of the small intestine, or sometimes the lower esophagus
  • Gastric/ Stomach ulcer: Pain may worsen with eating.
  • Duodenal ulcer: Ulcer of the first part of the intestines : Waking at night with upper abdominal pain + Upper abdominal pain that improves with eating.
  • Gastrin is a peptide hormone that stimulates secretion of gastric acid y Parietal cells of the stomach and aids in gastric motility.

Signs/ Symptoms		Related entities
Abdominal pain, classically epigastric, strongly correlated with mealtimes. In case of duodenal ulcers, the pain appears about three hours after taking a meal and wakes the person from sleep; Bloating and abdominal fullness; Waterbrash Nausea and copious vomiting; Loss of appetite and weight loss, in gastric ulcer Weight gain, in duodenal ulcer, as the pain is relieved by eating	Hematemesis Melena Rarely, an ulcer can lead to a gastric or duodenal perforation, which leads to acute peritonitis and extreme, stabbing pain, and requires immediate surgery. Complications may include bleeding, perforation, and blockage of the stomach. Bleeding occurs in as many as 15% of cases	Gastritis GERD Dyspepsia Flatulence Nausea Vomiting

Causes

	Dynamic	Static	Viral
Common	Helicobacter pylori	NSAIDs	DHF
Uncommon	Behçet's disease, Crohn's disease Liver cirrhosis Vasculitis	Tobacco smoking Stress as a result of other serious health conditions Zollinger–Ellison syndrome Gastrin-secreting tumors Gastric ischaemia Metabolic disturbances Upper abdominal radiotherapy	CMV EBV HSV-1 HSV- 2

Remedies

		Key Sign / Symptom		Modalities
H. Pylori + Peptic Ulcers	Arg-n	Best remedy for stomach ulcers. Sharp Ulcerative/ Burning pain in stomach Pain radiates to other regions of abdomen. Sometimes gnawing in nature.	Belching, nausea, vomiting may appear along with radiating pains. Stomach ulcer + Abdominal distension
	Kali-bi	Burning pain in abdomen + Belching + Nausea.		Amel with eating
	Graph
	Uran-n	Burning pain+ Nausea/ Vomiting + Bloating/ Burping
Stomach Burning	Ars	Severe Burning sensation Weakness and weight loss may also attend.	Stitching/ Stinging pain in abdomen. Gastritis	Night agg Warm drinks amel Nausea / Vomiting after eating or drinking (Even Slight or smell of food)
	Nux-v	Stomach Burning And Vomiting Vomiting after eating any solid or liquid food Even the smallest quantity of water is not tolerable and vomited soon. Abdomen Rumbling and gurgling Abdomen feels distended with gas. Pain is felt in the abdomen	Nausea, Vomiting, Eructation's, Flatulence, Heartburn Tightness/ Pressure in stomach after eating / Stomach region is touch sensitive	Passing stool brings momentary relief from pain. Eating even a little Spicy food Tobacco, Coffee Alcoholic drinks
Gastric round ulcer	Kali-bi	Gastric round ulcer +Heaviness in stomach soon after eating. Stomach load.	Low appetite in stomach ulcers.
H. Pylori + Bloated In Lower Abdomen	Lyc	Stomach ulcers + Burning Constrictive pains Marked Abdominal Fullness/ Flatulence esp in the lower part. Dyspepsia, gas and burping.	Little eating leads to a distended abdomen Pain amel from taking warm water. Bloating starts soon after eating. Agg: Farinaceous food like Cabbage and Beans
Bloated Abdomen And Burping	Carb-v	Stomach ulcers + Burning pain / soreness Stomach ulcers + Sour belching/ Heartburn. Stomach Pain extend to back. Bloating of abdomen is a major concern.	Eating the smallest amount of food, even light food, agg the symptoms Sour burps are prominent Distension of abdomen with flatus.	Epigastric area may also be sensitive and tender to touch.
Constant sore feeling in stomach	Hydr	Stomach ulcers + Weight loss/ Emaciation	Weakness and a loathing of food in epigastrium Cutting / Sharp pain in stomach Chronic gastritis / Cancer
Vomiting immediately after eating	Graph	Constrictive / Burning pain in stomach after eating.	Excessive belching, the taste of ingesta is also present
Burning Sensation amel By Cold Drinks	Phos	Nausea/ Vomiting, Bitter or sour burping Soreness in the pit of stomach. Gastritis + Peptic ulcers. (Ars)	Bitter belching	ُBurning in the stomach after eating
H.Pylori + Marked Abdomen Pain	Coloc	Agonizing, cutting pain in abdomen. Pain of colicky, gripping nature i	Gastritis	Pressure amel Bending double and downward amel
Sour / Acrid Taste Burps	Nat-p	Water-brash + Belching.	Intense acidity and flatulence
Belching	Ant-c	Constant belching Belching tastes of eaten food.	Dyspepsia and vomiting
H. pylori + Intense Nausea/Vomiting	Ip	Constant Nausea Vomiting of white glairy mucus or food		Nausea is not relieved even after vomiting

Banerji protocols
First line	Ars C3 one dose every 3 hour or 15 min before food Lyc C200 one dose every 2 days
Second line	Nat-p C30 BD
Third line	Symph 0 two doses daily

Tissue Salt Remedies

• NP: His stomach is sour and acidic. Sour vomiting, Eructation and sour reflux, sour diarrhea