peptic ulcer disease Flashcards

1
Q

what is peptic ulcer disease?

A
  • includes gastric or duodenal ulceration
  • a breach in the epithelium of the gastric of duodenal mucosa
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2
Q

main symptom of peptic ulcer disease

A
  • upper abdominal pain
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3
Q

other less common symptoms of peptic ulcer disease

A
  • nausea
  • indigestion
  • heartburn
  • loss of appetite
  • weight loss
  • bloated
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4
Q

2 of the most common causes of peptic ulcer

A
  • NSAID use
  • H pylori infection
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5
Q

Life factors that can contribute to development of peptic ulcer disease

A
  • smoking
  • alcohol
  • stress
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6
Q

H pylori infection + NSAID use

A

NSAIDs may have additive effect if co-existent infection, further increasing risk of peptic ulceration

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7
Q

Patients at high risk of developing GI complications with NSAID use

A
  • hx complicated peptic ulcer
  • or 2 or more of the following RF:
    • > 65
    • high dose NSAID
    • other drugs that increase risk of GI adverse effects e.g. Acs, CCs, SSRIs
    • serious comorbidity (e.g. CVD, hypertension, diabetes, RI or HI)
    • heavy smoker
    • excessive alcohol
    • previous adverse reaction to NSAIDs
    • prolonged use of NSAIDs
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8
Q

Lifestyle measures that can improve symptoms

A
  • healthy eating
  • weight loss
  • avoiding trigger foods
  • eating smaller meals
  • eating evening meal 3-4h before bed
  • raise head of bed
  • smoking cessation
  • reduced alcohol
  • anxiety, stress, depression can exacerbate
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9
Q

Urgent endoscopic investigation is needed in the following pt

A
  • dysphagia (difficulty swallowing)
  • significant acute GI bleed
  • 55 or over with unexplained weight loss and symptoms of upper abdominal pain, reflux or dyspepsia
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10
Q

Initial management of peptic ulcer disease

A
  • review and stop any drugs that induce peptic ulcers if appropriate (NSAIDs, aspirin, bisphosphonates, immunosuppressive e.g. CC, potassium chloride, SSRIs)
  • crack cocaine can also induce peptic ulcer
  • test pt for H pylori - if positive and no Hx NSAID use, eradicate infection
  • if associated with NSAID use, give PPI or H2RA for 8 weeks followed by eradication treatment if positive
  • If negative and no Hx NSAID use, give PPI or H2RA for 4-8 weeks
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11
Q

Pt has a peptic ulcer and you test for H pylori. What’s the treatment if they are positive, negative, or if it is NSAID associated

A
  • positive and no Hx NSAID use, eradication therapy
  • NSAID associated, PPI or H2RA 8 weeks, followed by H pylori eradication if positive
  • If negative and no hx NSAID use, give PPI or H2RA for 4-8 weeks
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12
Q

Follow up management for pt with peptic ulcers (gastric or duodenal) who tested positive for H pylori

A
  • review 6-8 weeks after starting eradication treatment and re-test depending on size of lesion
  • pt with gastric ulcer who tested positive for H pylori should also have repeat endoscopy 6-8 weeks after treatment to confirm ulcer healing, depending on size of lesion
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13
Q

Follow up management for pt with peptic ulcers (gastric or duodenal) - if the ulcer has healed, regarding NSAID treatment

A
  • if ulcer healed and pt is to continue taking NSAIDs, discuss potential harm from NSAID treatment
  • review need for NSAIDs every 6 months and use on a limited PRN basis trialled
  • consider reducing dose, substituting NSAID with paracetamol or using another alternative analgesic or low dose ibuprofen
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14
Q

Follow up management for pt with peptic ulcers (gastric or duodenal) - if pt has had previous ulceration

A
  • If NSAID continuation necessary, or if pt is at high risk of GI SE, consider COX-2 inhibitor instead of standard NSAID
  • GI protection with acid suppression therapy should always be coprescribed (PPI preferred, other options include H2RA or misoprostol but the latter has SE that limit its use)
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15
Q

Follow up management for pt with peptic ulcers (gastric or duodenal) - if symptoms recur after treatment

A

Take PPI at lowest dose possible to control symptoms
(on prn basis with pt managing their own symptoms)

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16
Q

Follow up management for pt with peptic ulcers (gastric or duodenal) - in cases of persistent symptoms of unhealed ulcer

A
  • check adherence to initial management and reinforce lifestyle advice
  • also consider other causes e.g. malignancy, failure to detect H pylori, inadvertent NSAID use, other ulcer-inducing meds, rare causes e.g. Crohn’s or Zollinger-Ellison syndrome
17
Q

Follow up management for pt with peptic ulcers (gastric or duodenal) - if response to PPI inadequate

A

May be beneficial to switch to alternative acid suppression therapy e.g. H2RA

18
Q

Refractory or recurrent peptic ulcers with gastro-oesophageal symptoms that are unexplained, or non-responsive to treatment

A
  • refer to specialist for investigations and management
19
Q

Patients with peptic ulcer disease who are on long treatment should be reviewed…

A

annually