Peptic Ulcer Disease

Question 1

What is peptic ulcer disease (PUD)?

Answer 1

Peptic ulcer disease (PUD) is an umbrella term for the development of two different ulcers: gastric ulcers and duodenal ulcers.

Question 2

What is the difference between erosions and ulcers?

Answer 2

• Erosion - superficial/partial break within the epithelium or mucosal surface.
• Ulcer - deep break through the full thickness of the epithelium or mucosal surface.

Question 3

What are the causes of PUD?

Answer 3

• H.pylori infection
• NSAID use
• corticosteroids
• alcohol
• zollinger-ellison syndrome
• acute stress
• malignancy
• inflammatory- Crohn’s

Question 4

What is the incidence of Gastric and duodenal ulcers in terms of age and gender?

Answer 4

Gastric ulcers- incidence increases with age, with equal gender distribution

Duodenal ulcers- more common in men, between the ages of 45-65 years.

Question 5

What are the symptoms of PUD?

Answer 5

• epigastric pain
• dyspepsia
• heartburn

Question 6

How would a patient with an acute upper GI bleed or perforation present or Gastric outlet obstruction?

Answer 6

Acute Upper GI bleed:
- Hematemesis+/- melena
- features of shock

Perforation:
- acute, severe abdominal pain & tenderness
- localized or generalized guarding
- features of shock

Gastric outlet obstruction:
- this may occur secondary to stricturing and narrowing resulting from inflammation, ulcers, scarring
- N&V
- upper abdominal pain
- distention
- succussion splash- a sloshing sound that indicates the presence of fluid & gas in an obstructed organ or body cavity

Question 7

What is the management for PUD?

Answer 7

• lifestyle factors- diet, weight loss if obese, smokinng and alcohol cessation)

PUD associated with H.pylori:

1) no association with NSAIDs- first-line triple therapy
2) association with NSAIDs-two months full-dose of PPI, then triple therapy

PUD not associated with H.pylori:
- 4-8 weeks of full dose PPI

H.pylori eradication: 7 day course of triple therapy

1) non-penicillin allergy:
- PPI
- Amoxcillin
- Clarithromycin/metronidazole

2) Penicillin allergy:
- PPI
- Clarithromycin
- metronidazole

Question 8

What investigations would you do for PUD?

Answer 8

• ECG
• H.pylori testing (breath test, serological test, stool antigen test, invasive- urease test, histology, culture)
• FBC (iron-deficiency anemia)
• Upper GI endoscopy (definitive diagnostic tool)

Question 9

What are the complications of PUD?

Answer 9

1) perforation
2) haemorrhage
3) Gastric outlet obstruction