Peptic ulcer

Question 1

What features are present in peptic ulcer disease?

Answer 1

Epigastric pain
Nausea and vomiting
Dyspepsia (indigestion)

If perforation:
Haematemesis - coffee ground vomiting
Melaena
Iron deficiency anaemia

Question 2

How can you differentiate between a duodenal and gastric ulcer?

Answer 2

Duodenal = epigastric pain when hungry, relieved by eating

Gastric = epigastric pain worsened by eating

Question 3

What risk factors lead to peptic ulcers?

Answer 3

H.pylori
Drugs - NSAIDS, steroids, SSRIs, bisphosphonates
Factors that increase acid - stress, alcohol, caffeine, smoking, spicy foods

Question 4

What investigations are carried out in peptic ulcer disease?

Answer 4

Endoscopy to perform rapid urease test (CLO test) to check for H.pylori
or stool antigen test

Question 5

What treatment is given in peptic ulcer disease?

Answer 5

If H.pylori -ve = proton pump inhibitor (PPI)

If H.pylori +ve = PPI + x2antibiotics for 7 days
e.g. amoxicillin and either clarithromycin or metronidazole
if penicillin allergy - give PPI plus clarithromycin and metronidazole for 7 days