Peptic Ulcer Flashcards
1
Q
How common is it?
A
Dyspepsia occurs in 40% if population annually – 13% have ulcer disease.
2
Q
Who does it affect?
A
People of any age, increase as you get older.
3
Q
What causes it?
A
Helicobacter pylori infection is associated with about 95% of duodenal ulcers and 80% of gastric ulcers. See risk factors.
4
Q
What risk factors are there (and how can they be reduced)?
A
- H. Pylori = main aetiological factor – associated with 95% of duodenal ulcers, 80% of gastric ulcers.
- NSAID use, pepsin, smoking, alcohol, bile acids, steroids, stress, changes in gastric mucin consistency (may be genetically determined).
5
Q
How does it present?
A
- Epigastric pain often related to hunger, specific foods, or time of day ± bloating, fullness after meals, heartburn, tender epigastrium.
- ALARM Symptoms – Anaemia (iron deficiency), Loss of weight, Anorexia, Recent onset/progressive symptoms, Melena/haematemesis, Swallowing difficulty.
Complications – Bleeding, perforation, malignancy, decreased gastric outflow.
6
Q
Which other conditions may present similarly?
A
- Non-ulcer dyspepsia, duodenal Crohn’s, TB, lymphoma, pancreatic cancer, oesophagitis/GOR, gastric malignancy, dueodenitis, gastritis.
7
Q
How would you investigate the patient?
A
- Upper GI endoscopy to exclude malignancy, multiple biopsies from ulcer rim and base (histology, H.Pylori) and brushings (cytology). Repeat endoscopy to check healing.
- C breath test is most accurate non-invasive H. pylori test
8
Q
What treatment/s would you consider? What risks and benefits of treatment are there?
A
- Lifestyle – Purge stress. Reduce alcohol and tobacco use, avoid any aggravating foods.
- H. pylori eradication – Triple therapy 80-85% effective at eradication.
- Drugs to reduce acid – PPIs are effective. H2 blockers also.
- Drug induced ulcers – Stop drug if possible. PPIs may be best for treating and preventing GI ulcers and bleeding in patients on NSAIDs or antiplatelet drugs
