GERD, Peptic Ulcer Disease

What is Gastroesophageal reflux disease (GERD)?

GERD is the return of stomach contents back into the esophagus due to the relaxation of the lower esophageal sphincter

What are the clinical manifestations of GERD?

1. Heartburn

2. Dyspepsia (indigestion)

If GERD is frequent, what can it do to the esophagus?

It can cause the esophagus to get esophagitis

What can long term GERD inflammation lead to?

Long term GERD inflammation can lead to fibrosis and precancerous lesions

What factors can increase the likelihood of GERD?

• Pregnancy

• Obesity

What is Peptic Ulcer Disease?

Peptic Ulcer Disease is the breakdown of the protective mucosal lining of the esophagus, stomach or duodenum

What are the 4 common complications Peptic Ulcer Disease causes?

HPPG

1. Hemorrhage → hematemesis (vomiting of blood), melena (black stool)

2. Perforation → ulcer erodes through wall

3. Penetration → ulcer erodes into another organ

4. Gastric/duodenal outlet obstruction

How does Helicobacter pylori penetrate mucin (protective mucous layer of the stomach)?

Helicobacter pylori releases urease, which neutralizes stomach acid and liquefies mucin

Which layers protect the stomach from acid?

The mucous and bicarbonate layers protect the stomach from acid

What do prostaglandins do regarding the stomach?

Prostaglandins inhibit acid secretion and stimulate mucous and bicarbonate secretion

What do NSAIDS do to prostaglandins?

NSAIDs inhibit prostaglandins

What age group do Gastric ulcers tend to develop in?

Gastric ulcers tend to develop in older people (55-65 yrs)

What are two major causes of Gastric Ulcers?

Gastric ulcer causes:

1. H. Pylori Infection

2. NSAIDS

What is the main clinical manifestation of Gastric ulcers?

Pain occurs immediately after eating

Which tends to be more chronic - Gastric Ulcers or Duodenal Ulcers?

Gastric Ulcers tend to be more chronic than Duodenal Ulcers

Which age group and gender do Duodenal Ulcers tend to develop in?

Duodenal Ulcers tend to develop in younger people, and more commonly in males

What are the two main causes of Duodenal Ulcers?

Duodenal Ulcer Causes:

1. H. Pylori infection

2. NSAIDS

What is the main clinical manifestation of Duodenal Ulcers?

Pain occurs 2-3 hours after eating

How can Peptic Ulcers be treated?

Through reducing acidity:

PAAH

1. Proton pump inhibitors

2. Antibiotics (for H. Pylori)

3. Antacids (calcium carbonate)

4. Histamine receptor antagonists