Peptic Ulcer Disease

Question 1

What are peptic ulcers?

Answer 1

A break in the mucosal lining of the stomach or duodenum >5mm in diameter down to the submucosa

Question 2

What is the pathophysiology of peptic ulcers?

Answer 2

Imbalance between damaging factors and mucosal lining

Question 3

What are risk factors for peptic ulcers?

Answer 3

H.pylori infection 
NSAID use
Family history 
Increasing age
Smoking

Question 4

What are the symptoms of peptic ulcers?

Answer 4

Epigastric pain
N+V
GI bleeding - haematemesis/melaena

Question 5

What are the investigations for a suspected peptic ulcer?

Answer 5

H.pylori test

• urea breath test
• stool antigen test

OGD
- look for evidence of ulcer

FBC
- rule out anaemia = GI bleeding

Question 6

What is the management of peptic ulcer disease if H.pylori positive?

Answer 6

PPI + clarithromycin + amoxicillin/metronidazole

Question 7

What is the management of peptic ulcer disease if H.pylori negative?

Answer 7

PPI

Question 8

What is the management of a peptic ulcer if there is evidence of bleeding?

Answer 8

Endoscopy

PPI

Question 9

What lifestyle advice is given to patients with peptic ulcer disease?

Answer 9

Avoid NSAIDs

Smoking cessation

Question 10

When should patients with peptic ulcer disease seek more help?

Answer 10

Blood in stools
Melaena
Haematemesis 
Vomiting 
Abdominal pain

Question 11

What follow up is given to patients with a peptic ulcer?

Answer 11

Gastric ulcer - repeat endoscopy in 8 weeks to check healing

Duodenal ulcer - no follow up endoscopy

H.pylori infection - retest after a month