Peptic Ulcer Disease

Question 1

What are the two features found in peptic ulcer disease?

Answer 1

H Pylori infection (70-90%)

Mucosal exposure to gastric acid secretion

Question 2

What four points can be made about the pathogenesis of H pylori causing peptic ulcers?

Answer 2

H pylori produces an intense inflammatory/immune response - an increase in proinflammatory cytokine production
Epithelial injury by bacterial toxins
H pylori increases gastric acid secretion
T cell and B cell proliferation

Question 3

What percentage of people infected with h pylori get peptic ulcers?

Answer 3

10-20%

Question 4

What is the mechanism of NSAID induced peptic ulcer disease?

Answer 4

Suppression of musocal prostaglandin secretion, leading to an increase in HCL secretion and a decrease in HCO3- secretion

Question 5

What other events can influence peptic ulcer formation?

Answer 5

Gastric hyperacidity
zollinger-ellison syndrome (HCL producing tumour)
cigarette smoking
corticosteroids
"stress"??

Question 6

What are the signs and symptoms of peptic ulcers?

Answer 6

epigastric pain, worse at night, or 1-3 hours after meals. Classically, pain is relieved with food/alkali
Nausea, vomiting, bloating, belching and significant weight loss

Question 7

What are the complications of peptic ulcers?

Answer 7

Bleeding/perforation
Malignant transformation in 2%
Pyloric stenosis

Question 8

What is the treatment for peptic ulcers?

Answer 8

Antibiotics - Amoxycillin (or metronidazole if intolerant) clarithromycin
Protein Pump inhibitors eg. omeprazole
Hydrogen receptor antagonist eg. ranitidine, cimetidine (may control symptoms)

Question 9

What is the definition of dyspepsia?

Answer 9

“chronic and recurrent abdominal discomfort, usually associated with eating” also known as indigestion

Question 10

What are alarm symptoms associated with dyspepsia?

Answer 10

Weight loss, bleeding, dysphagia, anaemia, age

Question 11

What criteria would indicate the need for gastroscopy?

Answer 11

Presence of alarm symptoms (weight loss, bleeding - malena, haematemasis, dysphagia, anaemia, advancing age)

Question 12

What would the management of dyspepsia be?

Answer 12

presence of alarm symptoms - endoscopy
NSAID use - stop
No alarm symptoms, no NSAIDS - test for Hpylori or treat with a trial of therapy (abs and ppi)