Peptic Ulcer Disease Flashcards
Peptic Ulcer Disease: What is it?
Peptic Ulcer Disease= ulceration of the mucosa of the stomach (gastric ulcer) or the proximal duodenum (duodenal ulcer), which is more common. Peptic ulcers can bleed into the upper GI.
Peptic Ulcer Disease: Risk Factors
Factors that disrupt the mucus barrier or increase stomach acid:
Risk factors that disrupt the mucus barrier are:
- Helicobacter pylori
- Non-steroidal anti-inflammatory drugs (NSAIDs)
- SSRIs, corticosteriods, bisphosphonates
Risk factors that increase stomach acid are:
- Stress
- Smoking
- Alcohol
- Caffeine
- Spicy foods
- Zollinger-Ellison syndrome: rare cause characterised by excessive levels of gastrin, usually from a gastrin secreting tumour
The risk of bleeding from a peptic ulcer is increased with the use of:
- Non-steroidal anti-inflammatory drugs (NSAIDs)
- Aspirin
- Anticoagulants (e.g., DOACs)
- Steroids
- SSRI antidepressants
Peptic Ulcer disease: Investigations
- FBC
- endoscopy
- endoscopy with biopsy
- During endoscopy, a rapid urease test (CLO test) can be performed to check for H. pylori. A biopsy is considered during endoscopy to exclude malignancy.
Peptic ulcer disease: Management
The core aspects of treating peptic ulcers are:
Stopping NSAIDs
Treating H. pylori infections
Proton pump inhibitors (e.g., lansoprazole or omeprazole)
Repeat endoscopy (at 4-8 weeks) may be performed to ensure the ulcer heals.
Peptic Ulcer Disease: Complications
Bleeding from the ulcer is a common and potentially life-threatening complication.
Perforation results in acute abdominal pain and peritonitis, requiring urgent surgical repair (usually laparoscopic).
Scarring and strictures can lead to a narrowing of the exit of the stomach, causing difficulty in emptying the stomach contents. This is known as gastric outlet obstruction and presents with early fullness after eating as well as upper abdominal discomfort, abdominal distention and vomiting, particularly after eating. This may be treated with balloon dilatation during an endoscopy or surgery.
Peptic Ulcer Disease: Symptoms
epigastric pain
nausea + vomiting
dyspepsia
duodenal ulcers - epigastric pain when hungry, relieved by eating
gastric ulcers then pain
gastric ulcers - epigastric pain worsened by eating
The signs of upper gastrointestinal bleeding are:
Haematemesis (vomiting blood)
Coffee ground vomiting
Melaena (black, tarry stools)
Fall in haemoglobin on a full blood count
Peptic Ulcer Disease:
Perforation
The symptoms of perforation secondary to peptic ulcer disease typically develop suddenly:
* epigastric pain, later becoming more generalised
* patients may describe syncope
Investigations
* An upright (‘erect’) chest x-ray is usually required when a patient presents with acute upper abdominal pain can show free air under the diaphragm
