Dyspepsia and

Peptic Ulcer
Disease
Physiology of gastric secretion
Patophysiology
Where’s the position of
dyspepsia and PUD
dyspepsia Dyspepsia is an umbrella term used to
encompass anumber of symptoms
thought to originate from the
uppergastrointestinal tract.
Secara global terdapat sekitar 15-40%
penderita dispepsia. Setiap tahun
gangguan ini mengenai 25% populasi
dunia. Prevalensi dispepsia di Asia
berkisar 8-30%.
 PUD,
Organic GERD,alcohol,
used of chronic
dyspepsia drugs
Postprandialdysp
Functional
eptic symptoms
(PDS) &
Nyeri atau tidak nyaman
Epigastric
perut bagian atas yang
painsyndrome(EP
kronis atau berulang, tanpa
abnormalitas pada S)
pemeriksaan fisik dan
endoskopi
Functional
Dyspepsia

Pathophysiology ?
Next….. This includes
Madisch et al,motility
2018
disorders,
sensorimotor
dysfunction
connected with
hypersensitivity to
mechanical and
chemical stimuli,
immune activation,
elevated mucosal
permeability in the
proximal small
intestine, and
disorders of the
autonomic and enteric
nervous systems
Next….. Madisch et al, 2018

Delayed gastric
emptying,
Impaired
accomodation,
Gastric
Hypersensitivity,
duodenal
hypersencitivity to
acid, duodenal
sensitivity to lipid,
inflamation and
immune, H pylori
Next…..
Management
1. Diet
Dyspepsia
2. Pada tipe nyeri epigastrium, lini pertama terapi bertujuan menekan
asam lambung (H2-blocker, PPI). Pada tipe distres postprandial, lini
pertama dengan prokinetik, seperti metoklopramid/domperidon
(antagonis dopamin), acotiamide (inhibitor asetilkolinesterase),
cisapride (antagonis serotonin tipe 3 /5HT3), tegaserod (agonis
5HT4), buspiron (agonis 5HT1a). Bila lini pertama gagal, PPI dapat
digunakan untuk tipe distres postprandial dan prokinetik untuk tipe
nyeri. Kombinasi obat penekan asam lambung dan prokinetik
bermanfaat pada beberapa pasien. Tidak ada terapi yang efektif
untuk semua pasien; berbagai terapi dapat digunakan secara
berurutan ataupun kombinasi.

3. Antidepresan trisiklik (amitriptilin 50 mg/hari, nortriptilin 10 mg/

hari, imipramin 50 mg/hari) selama 8-12 minggu cukup efektif
Next…
Next…
Next…
Peptic Ulcer Disease
Peptic Ulcer Disease (PUD) is disruption of the
mucosal integrity of the stomach and/or duodenum
leading to a local defect or excavation due to active
inflammation.

The most important contributing factors are H

pylori,NSAIDs, acid, and pepsin.

Pathogenesis ??
H. Pylori related ulcer
Beberapa faktor lain yang berkaitan dengan tempat
tinggal
juga dianggap berhubungan dengan infeksi H.
Pylori, misalnya hidup di daerah pedesaan, rumah
padat, air minum terkontaminasi. Pada kebiasaan
hidup, merokok ataupun konsumsi alkohol masih
kontroversial dalam hubungannya dengan risiko
infeksi H. pylori
Treatment H. Pylori
•Single-antibiotic regimens are ineffective in eradicating H. pylori
infection
and lead to microbial resistance. Combination therapy with two or
three antibiotics (plus acid-suppressive therapy) is associated with the
highest rate of H. pylori eradication.
• A PPI significantly enhances the effectiveness of H. pylori antibiotic
regimens containing amoxicillin and clarithromycin .
• A regimen of 10–14 days of treatment appears to be better than
shorter treatment regimens.
• Poor patient compliance is linked to the medication-related side
effects experienced by as many as half of patients taking triple-agent
regimens and to the inconvenience of three- or four-drug regimens
administered several times per day. Packaging that combines the daily
doses into one convenient unit is available and may improve patient
compliance.
Treatment PUD
 References
Goodman & Gilman, 2012, Dasar Farmakologi Terapi, Edisi 10, Editor Joel.
G. Hardman & Lee E. Limbird, Konsultan Editor Alfred Goodman
GilmanKatelaris, P., Glupczynski, Y., Burette, A., Rautelin, H., Kosunen, T.U.,
Seppälä, K., Bell, G.D., Powell, K., 1992. Eradicating Helicobacter pylori.
Lancet 339, 54–55.
Koduru, P., Irani, M., Quigley, E.M.M., 2018. Definition, Pathogenesis, and
Management of That Cursed Dyspepsia. Clin. Gastroenterol. Hepatol. 16,
467–479.
Madisch, A., Andresen, V., Enck, P., Labenz, J., Frieling, T., Schemann, M.,
2018. The diagnosis and treatment of functional dyspepsia. Dtsch. Arztebl. Int.
115, 222–232.
Purnamasari, L., 2017. Faktor Risiko , Klasifikasi , dan Terapi Sindrom
Dispepsia. Contin. Med. Educ. 44, 870–873.