Peptic Ulcer Disease

Question 1

Main causes of peptic ulcer disease

Answer 1

H. Pylori, NSAIDs, Zollinger-Ellison Syndrome, Smoking, Acid/Coffee consumption

Question 2

Relationship between H. Pylori, Smoking peptic ulcer disease, and mechanisms

Answer 2

90% DU, 70% GU are due to H. Pylori. Causes gastritis in antrum. CagA protein inserted into mucosal cells, changes morphology, replication and apoptosis.
VacA protein causes vacuole formation and suppresses local immune mechanisms.

This leads to decrease in somatostatin and reduction of inhibition of gastrin release. Gastrin stimulates gastric acid secretion.
Smoking impairs mucosal healing.

Question 3

How do NSAIDs causes peptic ulcers

Answer 3

NSAIDs inhibit COX enzymes especially COX-1. Inhibits prostaglandin synthesis- these are involved in decreasing acid secretion, promoting bicarbonate and mucus secretion. Also they increase blood flow to mucosa.

Question 4

Symptoms of peptic ulcer disease and differences between gastric and duodenal ulcers.

Answer 4

Peptic ulceration causes localised burning epigastric pain. Relieved by food in DU and antacids. Pain is worse at night, radiates to the back. Nausea and anorexia accompany pain. Bleeding and perforation can occur and noticed in vomit and faeces. Perforation into adjacent structures such as transverse colon causes fistulae.

Question 5

Discuss investigation of peptic ulcer disease and endoscopy

Answer 5

Endoscopy visualises ulceration and is required in all patients with ALARMS 55 symptoms. (Anorexia, Loss of Weight, Anaemia, Rapid Onset, Melaena, Swallowing Problems, Age >55).
All GU should be biopsied, exclude cancer.