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
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
H. Pylori Infection With 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.	In abdominal distension Arg-n is one of the most effective remedies for stomach ulcers.
	Kali-bi	Gastric symptoms include burning pain in abdomen, belching and nausea. All these symptoms get better with eating.
	Graph
	Uran-n	Uranium Nitricum is useful when burning pain, nausea, vomiting, bloating and burping are present.
Stomach Burning	Ars	Burning sensation is very severe Night agg Warm drinks amel Nausea / Vomiting may appear after eating or drinking something. Sight or smell of food may trigger nausea and vomiting in such cases. Weakness and weight loss may also attend. The use of this medicine is also indicated for	Stitching/ Stinging pain in abdomen. Gastritis as well as peptic ulcers.
Stomach Burning And Vomiting	Nux-v	Vomiting after eating any solid or liquid food, Even the smallest quantity of water is not tolerable and vomited soon. Rumbling and gurgling in the abdomen Abdomen feels distended with gas. Pain is felt in the abdomen  and passing stool brings momentary relief from pain. Stomach region is touch sensitive	Eating even the smallest amount of food. Spicy food, Tobacco, Coffee Alcoholic drinks	Nausea, Vomiting, Eructation's, Flatulence, Heartburn are concomitants Tightness and pressure may be felt in the stomach after eating.
Gastric round ulcer	Kali-bi	Gastric round ulcer cases with a feeling of heaviness in the stomach soon after eating. Stomach load.		Low appetite in stomach ulcers.
H. Pylori Infection + Bloated In Lower Abdomen	Lyc	Stomach ulcers + Burning, Constrictive pains Marked Abdominal Fullness/ Flatulence esp in the lower part. Little eating leads to a distended abdomen Dyspepsia, gas and burping.	Bloating starts soon after eating. Pain amel from taking warm water. 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 the stomach	Hydr	Treating stomach ulcers + Weight loss/ Emaciation	Weakness and a loathing of food in epigastrium	Cutting / Sharp pain in stomach Chronic gastritis
Vomiting immediately after eating	Graph	Gastric ulcers with vomiting immediately after eating food	Constrictive and burning pain in the stomach after eating.	Excessive belching, the taste of ingesta is also present
Burning Sensation amel By Cold Drinks	Phos	When a cold drink relieves pain of stomach ulcers. Nausea/ Vomiting, bitter or sour burping Soreness is felt in the pit of the stomach. Gastritis and peptic ulcers. (Ars)	Burning in the stomach after eating	ُBitter belching may also be experienced in such cases.
H.Pylori Infection With Marked Abdomen Pain	Coloc	H.Pylori is characterized by agonizing, cutting pain in the abdomen. Pain of colicky, gripping nature i	Pressure and bending double ( bending forward and downward at the waist)relieves pain.	It is well indicated to manage gastritis.
Burps Having Sour Taste	Nat-p	Belching of sour, acrid nature. Water brash may appear along with belching.	Intense acidity and flatulence is also marked.
Belching	Ant-c	It is recommended when belching is constant. Belching in such cases tastes mainly of eaten food.	Dyspepsia and vomiting may also be present.
H. pylori + Intense Nausea/Vomiting	Ip	Nausea is present all the time. Vomiting of white glairy mucus or food appears	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 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

• Gastritis
• GERD