Peptic Ulcer Disease

Question 1

How prevalent is peptic ulcer disease?

Answer 1

10% incidence

Question 2

Can peptic ulcer disease be cured?

Answer 2

Yes - however, it is a disease prone to remissions and exacerbations.

Question 3

What area of the body is affected by peptic ulcer disease?

Answer 3

• 20% of ulcers occur in the stomach

- 80% occur in the duodenum

Question 4

What structure is affected in peptic ulcer disease?

Answer 4

primarily affects the mucosa but can affect deeper layers as well

Question 5

What causes peptic ulcer disease?

Answer 5

Heliobacter pylori infection

Question 6

Heliobacter pylori bacteria are normally transient in the stomach, how are they able to infect the stomach?

Answer 6

1) producing cell adhesion molecules

2) producing urease to ultimately create bicarbonate and neutralize an area of the stomach

Question 7

How does Heliobacter pylori cause a peptic ulcer?

Answer 7

the mechanism is unclear but it is thought to be related to two things:

1) inflammatory response to the bacteria which also causes some damage to the stomach lining
2) hypergastrinemia (increased secretion of gastrin which causes the stomach to increase acid secretion)

Question 8

Risk factors in this disease impede the body’s defense. What are these risk factors?

Answer 8

• HCl and biliary acid
• steroids and NSAIDs
• chronic gastritis
• smoking, alcohol, caffeine all increase acid secretion
• stress

Question 9

What are the body’s defensive factors to protect against peptic ulcers?

Answer 9

• regulation of the secretion of acid
• intact perfusion
• regeneration of epithelial lining

Question 10

What are the manifestations of peptic ulcers?

Answer 10

• abdominal pain (burning, cramping)

- nausea and vomiting

Question 11

What are the complications of peptic ulcers?

Answer 11

• perforation (a penetrating ulcer can lead to peritonitis)
• hemorrhage
• gastric obstruction/duodenal obstruction (due to edema, spasm or scar tissue contraction)

Question 12

How are peptic ulcers diagnosed?

Answer 12

1) history
2) labs:
- urea breath test (ingest urea solution that has marked carbon, if there is urease in the stomach, the marked carbon will be excreted as carbon dioxide and exhaled)
- serology (antibodies)
- fecal antigens (surface markers of the bacteria excreted)
3) barium swallow with an x-ray
4) endoscopy to visualize ulcers

Question 13

How is peptic ulcer disease treated?

Answer 13

• antacids to increase the pH (but this doesn’t address the problem)
• triple regimen of:
  ~ histamine 2 receptor blockers to block secretion of acid in the stomach, plus two antibiotics
  OR
  ~ proton pump inhibitor to block the secretion of hydrogen ions (needed for HCl synthesis), plus two antibiotics
• surgery for complications

Question 14

What are some examples of proton pump inhibitors used in the treatment of peptic ulcer disease?

Answer 14

• losec
• nexium
• pariet

Question 15

What are some examples of histamine 2 receptor blockers used in the treatment of peptic ulcer disease?

Answer 15

• tagamet

- zantac

Question 16

What are some examples of antibiotics used in the treatment of peptic ulcer disease?

Answer 16

• amoxil
• biaxin
• flagyl

Question 17

What is the rationale behind the triple regimen used to treat peptic ulcer disease?

Answer 17

• antibiotics to eliminate the H. pylori

- histamine 2 receptor blocker or proton pump inhibitor to increase the pH and allow the ulcer to heal