Peptic Ulcer Disease

Question 1

What are the risk factors for peptic ulcers?

Answer 1

Factors disrupting mucus barrier: H.pylori and NSAIDs
Factors which increase stomach acid: Stress, alcohol, caffine, smoking, spicey foods

Question 2

What are the symptoms of peptic ulcers?

Answer 2

Epigastric discomfort or pain
Nausea and vomiting
Dyspepsia
early satiety

Question 3

What are the signs of an upper GI bleed?

Answer 3

Haematemesis
Coffee ground vomit
Melaena
Low Hb

Question 4

What are features specific to duodenal and gastric ulcers?

Answer 4

Duodenal - more common and relieved by eating
Gastric ulcers - worsened by eating

Question 5

What are the investigations for peptic ulcers?

Answer 5

• Endoscopy +/- biopsy
• H.pylori urease breath test

Question 6

What is the treatment for a H.pylori negative peptic ulcer?

Answer 6

1st line - PPI
2nd line - H2 antagonist
Then repeat endoscopy 4-8 weeks later to ensure ulcer heals

Question 7

Name some examples of an H2 antagonist

Answer 7

Famotidine
Nizatidine

Question 8

What is the treatment for H.pylori positive peptic ulcers?

Answer 8

• H.pylori eradication therapy then repeat endoscopy to ensure ulcer healed

Question 9

What are the complications of a peptic ulcer?

Answer 9

• Bleeding
• Perforation leading to peritonitis
• Scarring and strictures which can lead to narrowing and outflow obstruction