Peptic Ulcer Disease

Question 1

Less common causes of peptic ulcers are:

Answer 1

Burns
Head trauma
Crohn disease
Gastric cancer
Gastrinoma (Zollinger-Ellison syndrome)

Question 2

GU is

associated with weight

Answer 2

loss

Question 3

PUD Dx

Answer 3

Upper endoscopy** is the most accurate test. Radiologic testing such as an upper GI series can detect ulcers, but cannot detect the presence of either cancer or H. pylori.

Question 4

Cancer prevalence among PUD (GU & DU)

Answer 4

Cancer is present in

4% of those with GU but in none of those with DU.

Question 5

PUD Tx

Answer 5

If H. pylory +:
PPIs (as in -ve) + H.pylori erradication
=Clarithro+Amoxi

If Negative:
Trial of acid suppression medication (i.e., PPIs) for 4–8 weeks, followed by reevaluation

Question 6

PUD Tx if unresponsive

Answer 6

1.- urea/stool test/biopsy
GU=redo endoscopy r.o. CA
2.- metronidazole and tetracycline

consider Bismuth

Question 7

PUD what to do after Tx

Answer 7

Retest with stool antigen or breath test to confirm cure of Helicobacter. 30-60d

Question 8

The only use of tetracycline is

Answer 8

Helicobacter treatment

Question 9

PUD Tx if penicillin allergy

Answer 9

PPI+ Clari+ Metro

Question 10

Non-Ulcer Dyspepsia (NUD) dx

Answer 10

endoscopy: normal. no identified
etiology.
THO only mandatory for >55y or those w Alarm symp: (dysphagia, weight loss, anemia

Question 11

Non-Ulcer Dyspepsia (NUD) Tx

Answer 11

under 45 years old, treat empirically: PPI

Question 12

NUD if symptoms do not resolve with initial therapy

Answer 12

treat H. pylori if present