CHAPTER 13 Gastrointestinal Disorders
II. Peptic Ulcer Disease
A. Pathology
1. Peptic ulcers occur when the digestive juices that help food digest damage the walls of the stomach or duodenum. The most common cause is infection with a bacterium called Helicobacter pylori, or H. pylori. Another cause is the long-term use of nonsteroidal anti-inflammatory drugs (NSAID) such as aspirin and ibuprofen (e.g., Motrin, Advil) (Table 13-1). Spicy foods do not cause ulcers, but can aggravate them and make them worse.
E. Treatment
1. Because many ulcers are caused by H. pylori bacteria, an approach to peptic ulcer treatment that eradicates the bacteria and reduces the level of acid in the digestive system is used. The result of the treatment is pain relief and ulcer healing.
2. Histamine H2 antagonists or H2 blockers
3. Antibiotics
a) A combination of antibiotics is usually used to treat H. pylori infections because one antibiotic alone is not usually sufficient to eradicate the organism. (See Box 13-1)
5. Proton pump inhibitors (PPI)
a) Superior to H2 blockers in the healing, recurrence, and prevention of ulcers. Used preferentially with antibiotics in H. pylori eradication and ulcer treatment regimens.
c) Adverse effects and precautions
(1) All PPI are generally well tolerated. Occasionally, they may cause nausea, diarrhea, headache or serious allergic-type reactions.
d) Drug interactions
(1) Omeprazole, lansoprazole, esomeprazole: substrates and inhibitors of CYP450 3A4 phenytoin, warfarin
III. Gastroesophageal Reflux Disease
Table 13-1 Characteristics of H. pylori versus NSAID-induced ulcers
| H. pylori | Nonsteroidal anti-inflammatory drugs (NSAIDs) |
|---|---|
| Direct mucosal damage caused by hypergastrinemia | Direct mucosal damage associated with prostaslandin inhibition |
| Ulcers are superficial; chronically inflamed | Ulcers are deep; no inflammation |
| Symptoms: epigastric pain (may be nocturnal), nausea, indigestion, fatigue | Patients are usually asymptomatic; complications cause bleeding perforation |
Box 13-1 Treatment Regimens for H. Pylori
• Combination therapy of a proton pump inhibitor (PPI) plus two antibiotics is generally recommended for treating H. pylori.
C. Signs and symptoms
5. Several factors may worsen symptoms of the condition including spicy foods, fatty foods, chocolate, caffeine, tomato sauce, carbonated beverages, mint, alcoholic beverages, large meals, lying down after eating, some medications (e.g., sedatives, tranquilizers, or blood pressure drugs), and cigarette smoking.
IV. Inflammatory Bowel Disease
Get Clinical Tree app for offline access
D. Signs and symptoms
1. The symptoms of these two illnesses are similar, which often makes it difficult to distinguish between the two. In fact, about 10% of colitis (inflamed colon) cases cannot be diagnosed as either ulcerative colitis or Crohn’s disease. When physicians cannot diagnose the specific IBD, the condition is called indeterminate colitis.
2. IBD causes chronic inflammation in the gastrointestinal tract and may lead to complications, such as colon cancer. The most common symptoms of both ulcerative colitis and Crohn’s disease are diarrhea (ranging from mild to severe), abdominal pain, decreased appetite, and weight loss. If the diarrhea is extreme, it may lead to dehydration, increased heartbeat, and decreased blood pressure. As food moves through inflamed areas of the gastrointestinal tract, it may cause bleeding.
