Diagnosing of peptic ulcer and H.pylori
(1)Diagnosing an Ulcer
a) Apper gastrointestinal (GI) series
. An upper GI series is an X-ray of the esophagus
stomach, and duodenum.
The patient drinks a chalky liquid called barium to make these organs and any ulcers show up more
clearly on the X-ray
b) an endoscopy
( منظار المعدة )
An endoscopy is an exam that uses an endoscope, a thin, lighted tube with a tiny camera on the end.
This allows the doctor to see the lining of the esophagus, stomach, and duodenum.
. If an ulcer is bleeding, the doctor can use the endoscope to inject drugs that promote clotting
المنظار هو عبارة عن أنبوب طويل مرن غير سميك مزود بإضاءة و كاميرا صغيرة في نهايته يستطيع الطبيب المعالج من توجيه بحذر لفحص النسيج الداخلي للجهاز الهضمي العلوي
و ذلك بعد ضبط كافة أجهزة التحكم الأخرى المتعلقة به.
و تعرض الصورة التي تمتاز بكفاءة عالية على شاشة التلفاز معطيةً بذلك رؤية واضحة و تفصيلية و في كثير من الحالات يعتبر منظار المعدة أدق من الأشعة السينية
ويعد ذو فائدة كبرى في تشخيص و تقيم مشكلات مختلفة كآلام البلع و صعوبة البلع
أو آلام المعدة و البطن، النزيف والقرح و كذلك الأورام .
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(2)Diagnosing H. pylori
If an ulcer is found, the doctor will test the patient for H. pylori.
This test is important because
treatment for an ulcer caused by H. pylori is different from that
for an ulcer caused by NSAIDs
H. pylori is diagnosed through
blood
or
breath
or
stool
or
tissue tests.
Blood tests
are most common. They detect antibodies to H. pylori bacteria.
Blood is taken at the doctor's office through a finger
stick
Urea breath tests
the patient drinks a urea solution that contains a special carbon atom.
If H. pylori is present, it breaks down the urea, releasing the carbon.
The blood carries the carbon to the lungs, where the patient exhales it.
Stool tests
may be used to detect H. pylori infection in the patient's fecal matter.
Tissue tests
are usually done using the biopsy sample that is
removed with the endoscope.
فحص عينة القرحة الهضمية المأخوذة بالمنظار للتأكد من وجود أو عدم وجود البكتيريا
======قبل إضافة عينة القرحة +++++++++++=+تغير اللون للأحمر بسبب وجود
+++++++++++++++++++++++++++++= =البكتيريا الحلزونية في عينة القرحة
Treatment of Peptic Ulcer
Firstly:
Change your lifestyle
Avoid spicy food , fatty food and Acidic food
Stop Smoking
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a)Antacid
(MgOH +Al hydroxide)
Mucogel
May Cause Diarrhea
(NaHCO3)
fawar fruit
not recomended for long time because it cause hypercalcemia and renal failure and salt water rtention
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b)H2 Blocker
Which decreace HCl Secretion
(Ranitidine)
Ranitidine
1tab. 2 times Daily
if 300 mg 1 tab. Daily only
Zantac
1tab. 2 times Daily
if 300 mg 1 tab. Daily only
Aciloc
1tab. 2 times Daily
if 300 mg 1 tab. Daily only
(Famotidine)
Peptec
1tab. 2 times Daily
(Nizatidine)
Ulcfree
1tab. 2 times Daily
لم يذكر Cimetidine في H2 Blockers نظراً لآثاره الجانبية الخطيرة ومنها:
Carcinogenic
Gynecomastic in male
Galactorrhea in female
(Because it's Antiandrogenic)
Decrease m e t abolism of anti coagulant,
Thyophylline and Quinidine
Decrease absorption of some drugs an minerals
(Ketoconazole, Fe,B12)
C)proton pump inhibitor
Decrease HCl secretion
(omperazole)
Fast Cure
1Cap. 1 time Daily
Ulstop
1Cap. 1 time Daily
Gastroloc
1Cap. 1 time Daily
(pantoprazole)
controloc
1tab. 1 time Daily
D)prostaglandin analogue
Anti secretory + protective properties
(Misoprostol)
Misotac
1tab. 3 times Daily
Treatment of Heliocobacter Pylori
Triple therapy=omeprazole+2Antibiotic s for14 days
Heli - Cure
1tab. 1 time Daily
Counseling points on peptic ulcer
it's our role
Counseling is a sympathetic interaction between pharmacists and patients during which the pharmacist should
Give sufficient information and advice to enable patients to use medicine effectively and safely
Make sure that patients understand your instructions well, as counseling is not a lecture patients must be given a chance to ask questions
a) Counseling points on diet and life style changes
Øpatients of peptic ulcer disease can eat any thing and no specific food is contraindicated , but each patient know which kind of food can cause him pain , so he should avoid it
ØPatients should stop smoking and drinking alcohols as they delay healing
ØNSAIDs should be avoided ( in some certain cases NSAIDs must be taken , but under the physician supervision
ØPatients should eliminate psychological stress
b) counseling points on the medicine
PPIs heal peptic ulcer more rapidly and shouldn’t be taken with H2 blockers
- it is very important to persuade your patient that pain can be relieved before actual healing , so he should complete the coarse of treatment as recommended by the physician.
PPIs (e.g. omperazole- lanzoprazole…et)c
-One capsule or one tablet in the morning before breakfast from 4-8 weeks.
-to be swallowed as a whole / disperse tablets in water or mix tablets and capsule with fruit juice and yoghurt
H2- antagonists( ranitidine , famotidine…)
-it is preferred to take them at night as the acidity of the stomach increases at night.
Bismuth chelate
to be swallowed with half glass of water
-it may darken tongue and blacken faeces , so tell your patient that it is normal case..
-it should be taken half an hour before food, or antacids as the decrease its activity.
-Milk should not be drunk by it self during treatment , but small quantities may be taken in tea or coffee
Scuralfate:
Þ scuralfate can adsorb other drugs ,so dose spacing should occur 2 hours before or after its administration.
Þ It is 1st line for smokers as it doesn’t delay their healing
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N.B.
Not every patient will require extensive counseling and advice , but pharmacist can correctly identify those who do.Not all the pieces of information should be given to the patient as he may get confused , so pharmacist should select the most important points which differ from one patient to another..But remember the dispensed medicine will be labeled with the essential information.
Reference
BNF2006