Peptic ulcer disease

Question 1

What is peptic ulcer disease?

Answer 1

A break in the mucosal lining of the stomach or duodenum more than 5 mm in diameter, with depth to the submucosa. Ulcers smaller than this or without obvious depth are called erosions. Peptic ulcers result from an imbalance between factors promoting mucosal damage (gastric acid, pepsin, Helicobacter pylori infection, non-steroidal anti-inflammatory drug use) and those mechanisms promoting gastroduodenal defense (prostaglandins, mucus, bicarbonate, mucosal blood flow).

Question 2

What are the risk factors of peptic ulcer disease?

Answer 2

H Pylori
NSAIDs
Smoking
Age
FHx or personal Hx of peptic ulcer disease
ITU admission

Question 3

What are the signs and symptoms of peptic ulcer disease?

Answer 3

Abdominal pain
Pointing sign
Epigastric tenderness
Nausea or vomiting
Early satiety
Weight loss or anorexia
Diarrhoea
Anaemia
GI bleed
Hypotension
Succession splash

Question 4

What is the epidemiology of peptic ulcer disease?

Answer 4

One systematic review of the literature reported an annual incidence of 0.10% to 0.19% for physician-diagnosed peptic ulcer disease and a 1-year prevalence of 0.12% to 1.50%.

Question 5

What investigations might you do for peptic ulcer disease?

Answer 5

H Pylori breath or stool test
Upper GI endoscopy
FBC (anaemia, leukocytosis)

Question 6

How do you manage peptic ulcer disease?

Answer 6

> Endoscopy and blood transfusion
> PPI
> Surgery or embolisation via interventional radiology
> H2 antagonist
> H Pylori eradication
> Misoprostol

Question 7

What are the complications of peptic ulcer disease?

Answer 7

> Penetration
Gastric outlet obstruction
Upper GI bleed
Perforation

Question 8

What is the prognosis of peptic ulcer disease?

Answer 8

With proton-pump inhibitor (PPI) therapy, duodenal ulcers typically heal within 4 weeks and gastric ulcers within 8 weeks.