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 ===
|-
|
*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
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* 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
|}


=== Causes ===
=== Causes ===
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* HSV- 2
* HSV- 2
|}
|}
=== 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.


== Remedies ==
== Remedies ==
{| class="wikitable"
{| class="wikitable"
|+
|+
! colspan="2" |Banerji protocols
!
!Key Sign / Symptom
!
!Modalities
Triggers
|-
|
=== Arg-n ===
|
* '''Best remedy''' for stomach ulcers.
* Sharp Ulcerative/ Burning pain is felt in stomach
* Pain radiates to other regions of the abdomen.
|
|
* Sometimes gnawing in nature.
* Symptoms such as belching, nausea, vomiting may also appear along with these radiating pains.
* In abdominal distension Arg-n is one of the most effective remedies for stomach ulcers.
|-
|Nux-v
|
* Stomach ulcer that stomach region is touch sensitive
* Tightness and pressure may be felt in the stomach after eating.
|
* Eating even the smallest amount of food.
* Spicy food,
* [[Cigarette smoke poisoning|Tobacco]], Coffee
* Alcoholic drinks
|
* Nausea, Vomiting, Eructation's, Flatulence, Heartburn are concomitants
|-
|Kali-bi
|
* '''Gastric round ulcer''' cases with a feeling of heaviness in the stomach soon after eating.
* Stomach load.
|
|Low appetite in stomach ulcers.
|-
|
=== Lyc ===
|
* Stomach ulcers + Burning, Constrictive pains
* Marked Flatulence Abdominal Fullness/ Bloating
|
* Bloating starts soon after eating.
* Pain amel from taking warm water.
* Agg: Farinaceous food like Cabbage and Beans
|
|-
|
=== Carb-v ===
|
* Stomach ulcers + burning pain
* Stomach ulcers + Sour belching/ [[GERD, Gastroesophageal Reflux Disease|Heartburn]].
* Pain may extend from stomach to back.
|
* Eating the smallest amount of food, even light food, agg the symptoms
|
* Epigastric area may also be sensitive and tender to touch.
|-
|[[Hydr, Hydrastis Canadensis|Hydr]]
|
* Treating stomach ulcers +  Weight loss/ [[Emaciation]].
* Key symptom: Constant sore feeling in the stomach.
|
|
* Cutting and sharp pain in the stomach may also be present
* Weakness and a loathing of food in epigastrium
* Chronic gastritis
|-
|Graph
|
* Gastric ulcers with vomiting immediately after eating food
|
* Constrictive and burning pain in the stomach is experienced after eating.
|
* Excessive belching, the taste of ingesta is also present
|-
|Phos
|
* When a cold drink relieves pain of stomach ulcers.
|Burning in the stomach after eating
|
* ُour, bitter belching may also be experienced in such cases.
|}
{| class="wikitable"
|+
! colspan="2" |
== Banerji protocols ==
|-
|-
|First line
|First line
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|}
|}


=== [[Tissue Salt Remedies]] ===
== [[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


Revision as of 05:06, 16 December 2023

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

  • 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

Triggers

Arg-n
  • Best remedy for stomach ulcers.
  • Sharp Ulcerative/ Burning pain is felt in stomach
  • Pain radiates to other regions of the abdomen.
  • Sometimes gnawing in nature.
  • Symptoms such as belching, nausea, vomiting may also appear along with these radiating pains.
  • In abdominal distension Arg-n is one of the most effective remedies for stomach ulcers.
Nux-v
  • Stomach ulcer that stomach region is touch sensitive
  • Tightness and pressure may be felt in the stomach after eating.
  • Eating even the smallest amount of food.
  • Spicy food,
  • Tobacco, Coffee
  • Alcoholic drinks
  • Nausea, Vomiting, Eructation's, Flatulence, Heartburn are concomitants
Kali-bi
  • Gastric round ulcer cases with a feeling of heaviness in the stomach soon after eating.
  • Stomach load.
 Low appetite in stomach ulcers.

Lyc
  • Stomach ulcers + Burning, Constrictive pains
  • Marked Flatulence Abdominal Fullness/ Bloating
  • Bloating starts soon after eating.
  • Pain amel from taking warm water.
  • Agg: Farinaceous food like Cabbage and Beans

Carb-v
  • Stomach ulcers + burning pain
  • Stomach ulcers + Sour belching/ Heartburn.
  • Pain may extend from stomach to back.
  • Eating the smallest amount of food, even light food, agg the symptoms
  • Epigastric area may also be sensitive and tender to touch.
Hydr
  • Treating stomach ulcers + Weight loss/ Emaciation.
  • Key symptom: Constant sore feeling in the stomach.
  • Cutting and sharp pain in the stomach may also be present
  • Weakness and a loathing of food in epigastrium
  • Chronic gastritis
Graph
  • Gastric ulcers with vomiting immediately after eating food
  • Constrictive and burning pain in the stomach is experienced after eating.
  • Excessive belching, the taste of ingesta is also present
Phos
  • When a cold drink relieves pain of stomach ulcers.
 Burning in the stomach after eating
  • ُour, bitter belching may also be experienced in such cases.

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 two doses daily
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

Related entities

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