PEPTIC ULCER DISEASE Flashcards
Definition (4)
- Loss of the mucosa and exposure of underlying submucosa in or adjacent to an acid-bearing area
- Most occur in the stomach or proximal duodenum
- Duodenal ulcers are two to three times more common than gastric ulcers
- More common in elderly
Causes (4)
1- H.pylori
2- NSAIDS/aspirin (by reduced production of mucosal prostaglandins and inhibition of the cycle-oxygenate pathway COX-1)
3- Less common causes:
- Smoking
- Glucocorticoids
- Hyperparathyroidism, Zollinger-Ellison syndrome, Vascular insufficiency, Sarcoidosis, Crohn’s disease
4- Note: generally gastric ulcers are associated with decreased gastric acid production, while duodenal ulcers are associated with increased gastric acid
Clinical Features (3)
1- Burning epigastric pain (most common)
- Relieved by antacids
- Association with food:
- DU worse when hungry or at night
- Gastric ulcers worse with food
2- Nausea, heartburn, flatulence
3- May present with the complications:
- Perforation (most commonly in anterior wall of duodenum)
- Painless hemorrhage (UGIB) —> gastroduodenal artery commonly involved
- Gastric outlet obstruction: from edema/scarring (rare) —> copious projectile vomiting
Investigations (3)
1- Non-invasive testing for H.pylori infection
2- Endoscopy usually not indicated unless there are complications, but if done multiple biopsies from the center and edge of the ulcer are taken to distinguish benign from malignant ulcer (esp. if gastric ulcers)
3- Barium meal if gastric outlet obstruction is suspected
Management (3)
1- If ulcer associated with H.pylori —> eradication therapy (confirmed by either a urea breath test or fecal antigen testing)
2- H.pylori-negative peptide ulcers are usually associated with aspirin or NSAIDs and are treated with PPIs and stopping the offending medication
3- Follow-up endoscopy plus biopsy is performed for all GUs to demonstrate healing and exclude malignancy (initial biopsies may be false negatives)
