2. Peptic ulcer disease

Question 1

How common is it?

Answer 1

Quite

Duodenal ulcers are more common than gastric (3:1)

Question 2

Who does it affect?

Answer 2

Most commonly >60s

M>F

Question 3

What causes it?

Answer 3

H. pylori infection
NSAID / steroid use
Damage to the mucosal lining of the stomach

Question 4

What risk factors are there?

Answer 4

Smoking and alcohol
Severe stress
Increasing age

Question 5

How does it present?

Answer 5

Abdo pain
Loss of appetite
Nausea and vomiting
Heartburn / indigestion

Question 6

What signs might the patient have one examination?

Answer 6

Some epigastric tenderness

Anorexia or cachexia

Question 7

What other conditions might present similarly?

Answer 7

GORD
Gastric cancer
Gastritis
AAA, pancreatitis, angina

Question 8

How would you investigate?

Answer 8

H. pylori urea breath test / stool antigen test
Upper GI endoscopy, CXR
FBC (Hb - perforation)
U+Es (raised urea indicates upper GI bleed)

Question 9

What treatments are available?

Answer 9

Lifestyle modification
PPI, H2RAs
Amox + Clarith if H. pylori present