Peptic ulcer disease

Question 1

Pathophysiology?

Answer 1

The stomach mucosa is prone to ulceration from:

Breakdown of the protective layer of the stomach and duodenum
Increase in stomach acid
There is a protective layer in the stomach comprised of mucus and bicarbonate secreted by the stomach mucosa. This protective layer can be broken down by:

Medications (e.g. steroids or NSAIDs)
Helicobacter pylori

Question 2

What can increased acid be caused by?

Answer 2

Stress
Alcohol
Caffeine
Smoking
Spicy foods

Question 3

How does it present?

Answer 3

Epigastric discomfort or pain
Nausea and vomiting
Dyspepsia
Bleeding causing haematemesis, “coffee ground” vomiting and melaena
Iron deficiency anaemia (due to constant bleeding)

Question 4

How is it managed and investigated?

Answer 4

Peptic ulcers are diagnosed by endoscopy. During endoscopy a rapid urease test (CLO test) can be performed to check for H. pylori. Biopsy should be considered during endoscopy to exclude malignancy as cancers can look similar to ulcers during the procedure.

Medical treatment is the same as with GORD, usually with high dose proton pump inhibitors (omeprazole 20mg a day). Endoscopy can be used to monitoring the ulcer to ensure it heals and to assess for further ulcers.