**ACC (Y4)** Abdominal: Peptic Ulcers

Question 1

What is a peptic ulcer?

Answer 1

a break in the superficial epithelial cells penetrating down to the muscular mucosa of either the stomach or duodenum

Question 2

how are erosions differ from peptic ulcers?

Answer 2

erosions are superficial breaks in the mucosa alone

ulcers are superficial breaks penetrating down tot he muscular layer

Question 3

where are duodenum ulcers most commonly found?

Answer 3

duodenal cap

Question 4

where are stomach ulcers most commonly found?

Answer 4

most commonly seen on the lesser curve near the incisura - but can be found anywhere in the stomach

Question 5

which is more common, stomach or duodenal ulcers?

Answer 5

duodenum ulcer is more common

Question 6

what risk factors are associated with peptic ulcers?

Answer 6

• H.Pylori infection
• NSAID drug use
• Zollinger-Ellison syndrome
• Smoking
• Alcohol

Question 7

Why is there a considerable geographical variation with peptic ulcer disease?

Answer 7

peptic ulcer disease being more prevalent in developing countries related to the high H. pylori infection

In the developed world the percentage of NSAID-induced peptic ulcers is increasing, as the preva- lence of H. pylori declines.

Question 8

what are clinical features of peptic ulcers?

Answer 8

• Recurrent, burning epigastric pain.
• Pain of DU and GU may be relieved by antacids.
• Nausea.
• Anorexia/weight loss.
• Fatty food intolerance.
• Heartburn.
• Feeling of fullness, bloating or belching.
• Melaena/haematemesis.
• Swallowing difficulty.

Question 9

When does duodenum ulcer pain classically occur?

Answer 9

night time

Question 10

what is Odynophagia and what is it suggestive of?

Answer 10

pain during the act of swallowing and is suggestive of oesophagitis

Question 11

what does persistent/severe pain relating to a peptic ulcer suggest?

Answer 11

complications such as penetration into other organs

back pain suggests a penetrating posterior ulcer

Question 12

which conditions present in a similar way to a peptic ulcer?

Answer 12

• GORD

- Gallstones

Question 13

What investigations would you conduct if you suspected a peptic ulcer?

Answer 13

Test for H.Pylori using any of the following:

• urea breath test
• stool antigen test
• blood test

endoscopy/gastroscopy to confirm presence of an ulcer

Question 14

What is the treatment for a patient that tests positive for H.Pylori?

Answer 14

Proton pump inhibitor (PPI) twice daily and amoxicillin 1g twice daily and either clarithromycin 500mg twice-dailyor metronidazole 400mg twice-daily. (for 7 days)

antibiotic and PPI

Question 15

what is the role of antibiotics in the treatment of H.Pylori infection?

Answer 15

kill H. pylori.

Question 16

what is the role of a proton pump inhibitor (PPI) in the treatment of a peptic ulcer?

Answer 16

block acid production and promote healing

Question 17

what is the role of a H2 receptor antagonist in the treatment of a peptic ulcer?

Answer 17

reduce acid production

Question 18

what is the role of antacids in the treatment of a peptic ulcer?

Answer 18

neutralize stomach acid

Question 19

what are some common over the counter antacids?

Answer 19

gaviscon

Question 20

What is the treatment for a patient that tests positive for H.Pylori, but has a penicillin allergy?

Answer 20

If the person is allergic to penicillin, offer a 7-day triple therapy regimen of:

A PPI twice daily and clarithromycin 500 mg twice daily and metronidazole 400 mg twice-daily.

NB: the British National Formulary (BNF) recommends using clarithromycin 250 mg twice-daily for this regimen.

Question 21

what are the complications if peptic ulcers are left untreated?

Answer 21

• internal bleeding
• infection
• gastric obstruction
• perforation

Question 22

how can you prevent peptic ulcers?

Answer 22

• infection control (hand washing, preparing food well)

- use NSAIDs with caution

Question 23

what is a refractory ulcer?

Answer 23

an ulcer that has failed to heal

Question 24

what reasons may a peptic ulcer fail to heal?

Answer 24

• Over production of stomach acid (e.g. Zollinger-Ellison syndrome).
• An infection other than H. pylori.
• Stomach cancer.
• Other diseases that may cause ulcer-like sores in the stomach and small intestine, such as Crohn’s disease.

Question 25

should you prescribe a PPI/antibiotics before a stool sample or breath test has been done for H.Pylori?

Answer 25

No

The recommendation to avoid antibiotics and PPIs prior to testing is due to the fact that these drugs can suppress H. pylori and therefore lead to false negative results

Question 26

how would you treat a peptic ulcer in a patient who tested negative for h.pylori?

Answer 26

offer acid suppression with a full-dose PPI to people who test negative to H. pylori