peptic ulcer disease

Question 1

PUD is most commonly caused by

Answer 1

H pylori or NSAID use

Question 2

symptoms of PUD

Answer 2

epigastric pain or discomfort sometimes relieved by antacids
may be accompanied by nausea, vomiting or heart burn
symptoms may overlap significantly with with functional heartburn/dyspepsia and GORD

Question 3

peptic ulcer disease is made more likely with these symptoms

Answer 3

a remitting and relapsing course and nocturnal wakening with epigastric pin
documented history of an ulcer or a family history of ulcer disease
use of aspirin or other NSAID

Question 4

investigation

Answer 4

readily diagnosed by endoscopy
biopsy for histology and rapid urease test cn identify the presence of H pyrlori and exclude malignancy

Question 5

relative risk of defferent NSAIDs causing GI adverse events are influenced by

Answer 5

half life
dose and duration of therapy
COX selectivity eg. celecoxib is COX2 selective but aspirin in COX1 selective
patient specific risk factors eg. concurrent H pylori infection.

Question 6

risk factors for NSAID induced upper GI bleeding

Answer 6

older age
history of upper GI bleeding
history of peptic ulcer disease
H pylori infection
concomitant drugs including anticoagulants, antiplatelet drugs, SSRIs, SNRIs and corticosteroids
significant comorbidity
smoking

Question 7

treatment for NSAID induced ulcer

Answer 7

stop NSAID and gve PPI for 8-12 weeks