Peptic Ulcer Disease

Question 1

What are the common sites for peptic ulcer?

Answer 1

Duodenum ~80%

Stomach ~ 20%

Question 2

What are the causes for peptic ulcer?

Answer 2

Helicobacter pylori

• cause of 95% duodenual ulcers
• cause of 80% gastric ulcers

Drugs:

• NSAIDs
• Alendronate (treat osteroporosis in post menopause)
• High dose steroids

Zollinger-Ellison syndrome (genetic link)

Question 3

What is Zollinger-Ellison syndrome?

Answer 3

Gastrin secreting tumour in duodenum/pancreas

Leads to increased acid production

Question 4

How does Helicobacter pylori cause ulcers?

Answer 4

Infects antrum =>

Decreased somatostatin production =>

Prevents inhibition of gastrin/acid production

Question 5

What are the risk factors for PUD?

Answer 5

Male

Smoker

Excessive alcohol intake

Question 6

What is the typical presentation of PUD?

Answer 6

Pain - usually 1-3 hours post-prandial, night, can be relieved by food, antacids, milk

N&V

Haemorrhage/haematemesis
- iron deficiency anaemia

Gastric/GORD symptoms

Specific:

• pyloric stenosis - high volume, non-bilious vomiting
• perforation - peritonitis, pneumoperitoneum

Question 7

What would be done to investigate PUD?

Answer 7

Medication review - consider withdrawing any possible contributors

FBC - to look for anaemia

H pylori testing, either of:

• stool antigen test
• urea breath test
• serology (less sensitive/specific)

Endoscopy if: 
- Red flags:
  [] Bleeding - ID anaemia / haematemesis / malaena
  [] weight loss
  [] dysphagia
  [] epigastric mass
 - H pylori and NSAIDs negative
 - >55 and previous PU/gastric surgery/pernicious anaemia

Surgery if severe bleeding, perf, or pyloric stenosis

Question 8

What would be done to manage PUD?

Answer 8

Triple therapy

• PPI (or H2-receptor antagonist)
• 2 * Antibiotics - e,g, amoxicillin+clarithromycin (or metranidazole+clarithromycin)

If on NSAIDs, withdraw and treat with 8 weeks PPI to allow healing

Question 9

What does the ALARM symptoms acronym stand for?

Answer 9

A - anorexia
L - loss of weight
A - anaemia
R - recent onset of progressive symptoms
M - malaena