Peptic Ulcer Disease (2)

Question 1

What is it?

What’s the most common cause of Oesophageal ulcers?

What’s the most common cause of Gastric/Duodenal ulcers?

When is the stomach mucosa most prone to ulceration? What are the causes of these?

Answer 1

➊ Ulceration of mucosa in Lower oesophagus, Stomach, or Duodenum

➋ GORD

➌ H. Pylori Infection, NSAIDs

➍ Weakening of protective layer or an increase in gastric acid
• Protective layer weakened by NSAIDs and H. pylori
• Increased gastric acid due to Alcohol, Smoking, Caffeine, Stress, Zollinger-Ellison syndrome

Question 2

How does it present?

How can a gastric ulcer be differentiated from a duodenal ulcer?

Answer 2

➊ • Epigastric pain/discomfort
• Dyspepsia
• N+V
• Haematemesis/melaena if acute bleeding
• Anaemia if chronic bleeding

➋ • Eating worsens pain of a gastric ulcer
• Eating improves pain of a duodenal ulcer

N.B. When eating, the pylorus constricts, which is why the pain presents differently with the location of the ulcer

Question 3

How is it investigated?

What are the lifestyle changes to make?

What’s the medical option if H. Pylori negative?

What’s the medical option if H. Pylori positive?

Answer 3

➊ Endoscopy - Rapid Urease test (for H. pylori) and Biopsy (exclude malignancy)

➋ * Less alcohol, smoking, caffeine, stress
* Have more regular, smaller meals
* Avoid eating late night (3+ hrs before)
* Avoid acidic foods, fatty or spicy foods
* Weight loss

➌ 4-8 weeks of full-dose PPI

➍ Triple therapy of PPI + 2 Abx (Amoxicillin + Clarithromycin)

N.B. Metronidazole can be used if penicillin intolerant

Question 4

What’s its most common complication?
→ How does it present?

What are the other complications?

Answer 4

➊ Bleeding
→ • Large, acute bleed - haematemesis or melaena
• Small, chronic bleeds - anaemia

➋ • Perforation - leads to acute abdomen and peritonitis
• Stricture formation due to fibrotic healing - can present as an obstruction
• Malignancy - rare development of ca. from a peptic ulcer