Peptic Ulcer Disease Flashcards
Peptic ulcer may be…….2
Which ulcers are more common?
Which occurs more in younger adults?
Which occurs after middle age? And should be taken seriously because……
Peptic ulcers may lead to life threatening complications like……?
Definition of Peptic ulcer disease 🦠
Peptic ulcer may be duodenal or gastric.
Duodenal ulcers are more common and occur more often in younger adults.
Gastric ulcers usually occur after middle age.
Gastric ulcers should be taken seriously because they may be malignant.
Peptic ulcers may lead to life threatening complications of
— bleeding,
— perforation and
— gastric outlet obstruction.
Peptic ulcer disease (PUD) is the presence of one or more ulcerative lesions in the stomach or duodenum.
A sore that develops on the lining of the oesophagus, stomach or small intestine.
Ulcers occur when stomach acid damages the lining of the digestive tract.
Common causes include
— the bacteria H. Pylori and
— anti-inflammatory pain relievers including aspirin.
Etiology of PUD
Causes
y Helicobacter pylori (H. pylori) infection
y Excessive secretion of gastric acid
y Inadequate protection of the lining of the stomach and duodenum
against digestion by acid and pepsin
y Medicines
e.g.
— non-steroidal anti-inflammatory drugs (NSAIDs),
— corticosteroids
—Infection with Helicobacter pylori (most common),
— prolonged NSAID use (NSAID-induced ulcer),
—conditions associated with an overproduction of stomach acid (hypersecretory states), and
— stress.
The most common causes of peptic ulcers are
— infection with the bacterium Helicobacter pylori (H. pylori) and
— long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve).
Risk factors
Risk factors
In addition to having risks related to taking NSAIDs, you may have an increased risk of peptic ulcers if you:
—Smoke. Smoking may increase the risk of peptic ulcers in people who are infected with H. pylori.
—Drink alcohol. Alcohol can irritate and erode the mucous lining of your stomach, and it increases the amount of stomach acid that’s produced.
—Have untreated stress.
—Eat spicy foods.
Signs and Symptoms of PUD
Symptoms
y Episodic abdominal pain (often aggravated by dietary indiscretions and lifestyle)
y May be a minor discomfort, gnawing, burning, dull ache or very severe pain
y Typically pain is in the epigastrium or right hypochondrium
y Occasionally high up behind the sternum or low down around
the umbilicus
y In duodenal ulcer, pain typically comes on when the patient is
hungry and may wake the patient up in the middle of the night.
y In gastric ulcer, it is typically worsened by food, and may be re-
lieved by vomiting
y Is relieved by alkalis and food in duodenal ulcer
y Vomiting may occur in both duodenal and gastric ulcers. It is usually a complication in duodenal ulcer (gastric outlet obstruction) but may be self-induced in gastric ulcer to relieve pain
In children
y Pain may be peri-umbilical
Signs
y There may be no abdominal signs
y Weight loss (sometimes in gastric ulcer)
y Weight gain (sometimes in duodenal ulcer)
y Tenderness - epigastrium, right hypochondrium or umbilical region
Epigastric pain is a typical symptom of PUD; however, many patients remain asymptomatic.
Symptoms
Burning stomach pain
Feeling of fullness,
bloating or belching
Intolerance to fatty foods
Heartburn
Nausea
The most common peptic ulcer symptom is burning stomach pain. Stomach acid makes the pain worse, as does having an empty stomach.
The pain can often be relieved by eating certain foods that buffer stomach acid or by taking an acid-reducing medication, but then it may come back. The pain may be worse between meals and at night.
Many people with peptic ulcers don’t even have symptoms.
Less often, ulcers may cause severe signs or symptoms such as:
Vomiting or vomiting blood — which may appear red or black
Dark blood in stools, or stools that are black or tarry
Trouble breathing
Feeling faint
Nausea or vomiting
Unexplained weight loss
Appetite changes
Investigations
Investigations
— Upper GI endoscopy
y Haemoglobin
y H. pylori stool antigen
y Oesophago-gastro-duodenoscopy (endoscopy)
y Barium meal (in the absence of endoscopy)
y Stool examination (to exclude intestinal parasites)
Complications
Complications
Left untreated, peptic ulcers can result in:
Internal bleeding. Bleeding can occur as slow blood loss that leads to anemia or as severe blood loss that may require hospitalization or a blood transfusion. Severe blood loss may cause black or bloody vomit or black or bloody stools.
A hole (perforation) in your stomach wall. Peptic ulcers can eat a hole through (perforate) the wall of your stomach or small intestine, putting you at risk of serious infection of your abdominal cavity (peritonitis).
Obstruction. Peptic ulcers can block passage of food through the digestive tract, causing you to become full easily, to vomit and to lose weight either through swelling from inflammation or through scarring.
Gastric cancer. Studies have shown that people infected with H. pylori have an increased risk of gastric cancer.
Prevention
Prevention
You may reduce your risk of peptic ulcer if you follow the same strategies recommended as home remedies to treat ulcers. It also may be helpful to:
Protect yourself from infections. It’s not clear just how H. pylori spreads, but there’s some evidence that it could be transmitted from person to person or through food and water.
You can take steps to protect yourself from infections, such as H. pylori, by frequently washing your hands with soap and water and by eating foods that have been cooked completely.
Use caution with pain relievers. If you regularly use pain relievers that increase your risk of peptic ulcer, take steps to reduce your risk of stomach problems. For instance, take your medication with meals.
Work with your doctor to find the lowest dose possible that still gives you pain relief. Avoid drinking alcohol when taking your medication, since the two can combine to increase your risk of stomach upset.
If you need an NSAID, you may need to also take additional medications such as an antacid, a proton pump inhibitor, an acid blocker or cytoprotective agent. A class of NSAIDs called COX-2 inhibitors may be less likely to cause peptic ulcers, but may increase the risk of heart attack.
Erosions are more superficial than ulcers. Ulcers involve damage to the gastric mucosa extending beyond the muscularis mucosa layer into the submucosa.
Usually, patients younger than 60 years of age can be managed with a test-and-treat strategy for H. pylori infection or with empirical acid suppression therapy. Older patients and those with high-risk clinical features benefit from an esophagogastroduodenoscopy (EGD) and biopsies to confirm the diagnosis or rule out differential diagnoses (especially gastric cancer). First-line treatment for most peptic ulcers involves symptom control (e.g., acid-lowering medication), H. pylorieradication therapy, and withdrawal of causative agents. Antisecretory drugs (e.g., proton-pump inhibitors), which reduce stomach acid production, are continued for 4–8 weeks after eradication therapy and may be considered for maintenance therapy if symptoms recur. Surgical intervention may be considered in rare cases. Some patients benefit from endoscopic surveillance, especially if symptoms persist or there is clinical suspicion for malignancy.
Treatment
STG page 23
