General: Peptic Ulcer Disease

Question 1

Describe the pathophysiology of peptic ulcer disease?

Answer 1

Break in the lining of the GI tract, extending through to the muscular layer (the muscularis mucosae)

Most often on the lesser curvature of the proximal stomach or the first part of the duodenum

Question 2

What causes peptic ulcer disease?

Answer 2

Helicobacter pylori = uric acid to ammonia = inflam response

NSAIDs = inhib prostaglandin synthesis = reduced secretion of glycoprotein, mucous, phospholipids by the gastric ep cells

High alcohol use

Foreign body ingestion

Question 3

How does peptic ulcer disease present?

Answer 3

70% asymptomatic

Gastric = epigastric pain (exacerbated by eating), Nausea and anorexia, weight loss

Duodenal = epigastric pain (2-5 hours after consuming after a meal)

Question 4

How should peptic ulcer disease be investigated?

Answer 4

OGD = definitive investigation

Biopsies = histology and rapid urease CLO test (identifies H.Pylori)

FBC = identify anaemia

Non-invasive Pylori testing (Carbon-13 urea breath test, serum Ab to H. pylori, stool Ag test)

Question 5

What is the best management for peptic ulcer disease?

Answer 5

Acute:

• A-E approach
• NBM
• IV fluids
• analgesia
• Bloods, amylase, lactate
• Erect CXR/CTAP (if no air under diaphragm)
• Surgery

Lifestyle = smoking cessation, weight loss, reduction in alcohol consumption

Avoidance of NSAIDs where possible

PPI for 8 weeks = omeprazole, lansoprazole

H.Pylori triple therapy = PPI with oral amoxicillin and clarithromycin for 7 days

Repeat endoscopy towards the end of PPI therapy = check for resolution

Question 6

Name some possible complications of peptic ulcer disease

Answer 6

Perforation

Haemorrhage

Pyloric stenosis

Posterior duodenal ulcer = gastroduodenal artery perforation

Posterior gastric ulcer = splenic artery perforation