Peptic ulcer Flashcards
How common is it?
Duodenal ulcers - 10% of adult population
Gastric ulcers - 3rd less common than duodenal ulcers
Who does it affect?
Adults
Age
NSAIDs use
H. pylori infection (much more common in developing countries)
What causes it?
Infection with Helicobacter pylori
NSAID abuse
What risk factors are there?
Age
Developing country
NSAID use
How does it present/what are the symptoms?
Recurrent, burning epigastric pain
Worse when patient is hungry
Nausea/vomiting
Anorexia/weight loss
What signs might there be on examination?
Nil of note
What other conditions may present similarly?
MI
GORD
Erosions (gastritis etc)
How would you investigate this patient?
Investigations for H. pylorus
- CO2 breath test
- IgG antibodies
- Stool antigen test
- Biopsy urease test
- Histology
- Culture
Endoscopic diagnosis and exclusion of cancer is required in patients >55 incl biopsy of all gastric ulcers.
Also required in all patients who present ‘alarm’ symptoms
What are ‘alarm’ symptoms?
Dysphagia Weight loss Vomiting Anorexia Haematemesis or melena
What would you tell the patient?
Stomach ulcers, also known as gastric ulcers, are open sores that develop on the lining of the stomach.
With treatment, most stomach ulcers will heal within a month or two. The treatment recommended for you will depend on what caused the ulcer.
Most people will be prescribed a medication called a proton pump inhibitor (PPI) to reduce the amount of acid their stomach produces, and allow the ulcer to heal naturally.
If an H. pylori infection is responsible for the ulcers, antibiotics will also be used to kill the bacteria, which should prevent the ulcer coming back.
What treatments would you discuss with the patient?
H.pylori eradication - metronidazole, clarithromycin, amoxicillin, tetracycline and bismuth
Long-term PPI therapy
Surgery (only for recurrent complications) vagotomy, gastrectomy
