Peptic ulcer disease: Difference between revisions

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* PUD is a break in the inner lining of the stomach, the first part of the small intestine, or sometimes the lower esophagus  
* PUD is a break in the inner lining of the stomach, the first part of the small intestine, or sometimes the lower esophagus  
** '''Gastric ulcer''': Stomach ulcer:  Pain may worsen with eating.  
** '''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.
** '''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 and symptoms[edit] ===
{| class="wikitable"
 
|+
* 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;
! colspan="2" |
=== 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;
* Bloating and abdominal fullness;
* Waterbrash
* Waterbrash
Line 13: Line 20:
* Loss of appetite and weight loss, in gastric ulcer
* Loss of appetite and weight loss, in gastric ulcer
* Weight gain, in duodenal ulcer, as the pain is relieved by eating
* Weight gain, in duodenal ulcer, as the pain is relieved by eating
* Hematemesis
|
*Hematemesis
* Melena
* 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.
* 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
* Complications may include bleeding, perforation, and blockage of the stomach. Bleeding occurs in as many as 15% of cases
|
*[[Gastritis]]
*[[GERD, Gastroesophageal Reflux Disease|GERD]]
*[[Dyspepsia]]
*[[Flatulent remedies|Flatulence]]
*Nausea
*Vomiting
|}


=== Causes ===
=== Causes ===
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|}
|}


== Remedies ==
{| class="wikitable"
|+
!
!
!Key Sign / Symptom
!
!Modalities
|-
| rowspan="4" |'''<big>H. Pylori + Peptic Ulcers</big>'''
|
=== [[Arg-n, Argentum Nitricum|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, kalium Bichromicum|Kali-bi]] ===
| rowspan="2" |
* Burning pain in abdomen + Belching + Nausea.
| rowspan="2" |
| rowspan="2" |
* Amel with eating
|-
|
=== [[Graph, Graphites|Graph]] ===
|-
|
=== [[Uran-n, Uranium Nitricum|Uran-n]] ===
|
* Burning pain+ Nausea/ Vomiting + Bloating/ Burping
|
|
|-
| rowspan="2" |'''<big>Stomach Burning</big>'''
|
=== [[Ars, Arsenicum Album|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 , Nux Vomica|Nux-v]] ===
|
* '''Stomach Burning And Vomiting'''
* V'''omiting 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
* [[Cigarette smoke poisoning|Tobacco]], Coffee
* Alcoholic drinks
|-
|'''<big>Gastric round ulcer</big>'''
|
=== [[Kali-bi, kalium Bichromicum|Kali-bi]] ===
|
* '''Gastric round ulcer''' +Heaviness in stomach soon after eating.
* Stomach load.
|
* Low appetite in stomach ulcers.
|
|-
|'''<big>H. Pylori + Bloated In Lower Abdomen</big>'''
|
=== Lyc ===
|
* Stomach ulcers + Burning
* Constrictive pains
* Marked  Abdominal Fullness/ [[Flatulent remedies|Flatulence]] esp '''in the lower part.'''
* Dyspepsia, gas and burping.
| colspan="2" |
* 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
|-
|'''<big>Bloated Abdomen And Burping</big>'''
|
=== [[Carb-v, Carbo vegetabilis|Carb-v]] ===
|
* Stomach ulcers + Burning pain / soreness
* Stomach ulcers + Sour belching/ [[GERD, Gastroesophageal Reflux Disease|Heartburn]].
* Stomach Pain extend  to back.
* B'''loating''' 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.
|-
|'''<big>Constant sore feeling in stomach</big>'''
|
=== [[Hydr, Hydrastis Canadensis|Hydr]] ===
|
* Stomach ulcers +  Weight loss/ [[Emaciation]]
| colspan="2" |
* Weakness and a loathing of food in epigastrium
* Cutting / Sharp pain in stomach
* Chronic [[gastritis]] / [[Cancer]]
|-
|'''<big>Vomiting immediately after eating</big>'''
|[[Graph, Graphites|Graph]]
|
* Constrictive / Burning pain in stomach after eating.
|
* Excessive belching, the taste of ingesta is also present
|
|-
|'''<big>Burning Sensation amel By Cold Drinks</big>'''
|
=== [[Phos, Phosphorus|Phos]] ===
|
* Nausea/ Vomiting,
* Bitter or sour burping
* Soreness in the pit of stomach.
* '''Gastritis''' + '''Peptic ulcers'''. ([[Ars, Arsenicum Album|Ars]]) 
|
* Bitter belching
|
* ُBurning in the stomach after eating
|-
|'''<big>H.Pylori +  Marked Abdomen Pain</big>'''
|
=== [[Coloc, Colocynthis|Coloc]] ===
|
* '''Agonizing''', cutting pain in abdomen.
* Pain of colicky, gripping nature i
|
* [[Gastritis]]
|
* Pressure amel
* Bending double and downward amel
|-
|'''<big>Sour / Acrid Taste Burps</big>'''
|
=== [[Nat-p, Natrium Phosphoricum|Nat-p]] ===
|
* Water-brash +  Belching.
|
* Intense acidity and flatulence
|
|-
|'''<big>Belching</big>'''
|
=== [[Ant-c, Antimonium Crudum|Ant-c]] ===
|
* '''Constant belching'''
* Belching tastes of eaten food.
|
* [[Dyspepsia]] and vomiting
|
|-
|'''H. pylori''' + '''Intense Nausea/Vomiting'''
|
=== [[Ip, Ipecacuanha|Ip]] ===
|
* Constant Nausea
* Vomiting of white glairy mucus or food
|
|
* Nausea is not relieved even after vomiting
|}
{| class="wikitable"
|+
! colspan="2" |
== Banerji protocols ==
|-
|'''First line'''
|
* [[Ars, Arsenicum Album|Ars]] C3 one dose every 3 hour or 15 min before food
* [[Lyc , Lycopodium clavatum|Lyc]] C200 one dose every 2 days
|-
|'''Second line'''
|
* [[Nat-p, Natrium Phosphoricum|Nat-p]] C30 BD
|-
|'''Third line'''
|
* [[Symph, Symphytum Officinale|Symph]] 0 two doses daily
|}


 
== [[Tissue Salt Remedies]] ==
=== Gastrin ===
 
* Gastrin is a peptide hormone that stimulates secretion of gastric acid  by Parietal cells of the stomach and aids in gastric motility.
* It is released by G cells in the pyloric antrum of the stomach, duodenum, and the pancreas.
* Gastrin is released in response to certain stimuli including
** Stomach antrum distension
** Vagal stimulation
** Presence of partially digested proteins, especially amino acids, in the stomach. Aromatic amino acids are particularly powerful stimuli for gastrin release.
** Hypercalcemia 
* Gastrin release is inhibited by
** Presence of acid in stomach
** Somatostatin
 
==== Function ====
G cell is visible near bottom left, and gastrin is labeled as the two black arrows leading from it. Note: this diagram does not illustrate gastrin's stimulatory effect on ECL cells.
The presence of gastrin stimulates parietal cells of the stomach to secrete hydrochloric acid (HCl)/gastric acid. This is done both directly on the parietal cell<sup>[''failed verification'']</sup> and indirectly via binding onto CCK2/gastrin receptors on ECL cells in the stomach, which then responds by releasing histamine, which in turn acts in a paracrine manner on parietal cells stimulating them to secrete H+ ions. This is the major stimulus for acid secretion by parietal cells.
 
Along with the above-mentioned function, gastrin has been shown to have additional functions as well:
 
* Stimulates parietal cell maturation and fundal growth.
* Causes chief cells to secrete pepsinogen, the zymogen (inactive) form of the digestive enzyme pepsin.
* Increases antral muscle mobility and promotes stomach contractions.
* Strengthens antral contractions against the pylorus, and relaxes the pyloric sphincter, which increases the rate of gastric emptying.
* Plays a role in the relaxation of the ileocecal valve.
* Induces pancreatic secretions and gallbladder emptying.
* May impact lower esophageal sphincter (LES) tone, causing it to contract, - although pentagastrin, rather than endogenous gastrin, may be the cause.
* Gastrin contributes to the gastrocolic reflex.
 
 
==== Role in disease ====
In the Zollinger–Ellison syndrome, gastrin is produced at excessive levels, often by a gastrinoma gastrin-producing tumor, mostly benign of the duodenum or the pancreas. To investigate for hypergastrinemia high blood levels of gastrin, a "pentagastrin test" can be performed.
 
In autoimmune gastritis, the immune system attacks the parietal cells leading to hypochlorhydria low stomach acid secretion. This results in an elevated gastrin level in an attempt to compensate for increased pH in the stomach. Eventually, all the parietal cells are lost and achlorhydria results leading to a loss of negative feedback on gastrin secretion. Plasma gastrin concentration is elevated in virtually all individuals with mucolipidosis type IV (mean 1507 pg/mL; range 400-4100 pg/mL) (normal 0-200 pg/mL) secondary to a constitutive achlorhydria. This finding facilitates the diagnosis of patients with this neurogenetic disorder. Additionally, elevated gastrin levels may be present in chronic gastritis resulting from ''H pylori'' infection.
 
 
 
=== [[Tissue Salt Remedies]] ===
 
* '''[[NP, Tissue Salt Remedy|NP]]''': His stomach is sour and acidic. Sour vomiting, Eructation and sour reflux, sour diarrhea
* '''[[NP, Tissue Salt Remedy|NP]]''': His stomach is sour and acidic. Sour vomiting, Eructation and sour reflux, sour diarrhea


===Related entities===
*
*[[Gastritis]]

Latest revision as of 11:22, 9 January 2024

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

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
  • 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
  • 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.
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
Third line

Tissue Salt Remedies

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