PEPTIC ULCER DISEASE

Question 1

WHAT IS PEPTUC ULCER DISEASE?

Answer 1

• Break in the lining of the GI tract, extending through to muscular layer (muscularis mucosa) of bowel wall
  Commonly in lesser curvature of proximal stomach or first part of duodenum
• Normal GI mucosa protected by surface mucous secretion and HCO3- ion release, PUD occurs when there is an imbalance in factors that protect mucosa and factors that damage it. Commonly, presence of Helicobacter Pylori or NSAIDS (inhibit prostaglandin synthesis, reduced protective effects in gastric mucosa).

Question 2

WHAT ARE THE RISK FACTORS FOR PUD?

Answer 2

1) Helicobacter pylori infection
2) Prolonged NSAIDS use
3) Corticosteroid use with NSAIDs

Question 3

WHAT ARE THE CLINICAL FEATURES OF PUD?

Answer 3

1) Majority asymptomatic
2) Epigastric/ retrosternal pain- pain from gastric ulcer exacerbated by eating, whilst duodenal ulcers worse 2-4 hours after eating.
3) Nausea
4) Bloating
5) Early satiety

Question 4

WHAT ARE THE DIFFERENTIAL DIAGNOSIS FOR PUD?

Answer 4

1) GORD
2) Gallstone disease
3) Gastric malignancy
4) Pancreatitis

Question 5

WHAT INVESTIGATIONS ARE CARRIED OUT FOR PUD?

Answer 5

1) FBC- look for anaemia
2) H.pylori testing (especially younger patients)- urea breath test, serum antibodies, stool antigen test. Patients should stop medical therapy prior to H.pylori test.
3) OGD in older patients with red flag symptoms or those with ongoing symptoms despite empirical treatment. At endoscopy peptic ulceration biopsied (due to malignant potential) and sent for histology and rapid urease test

Question 6

WHAT LIFESTLYE MANAGEMENT IS THERE FOR PUD?

Answer 6

1) Stop taking NSAIDs
2) Smoking cessation
3) Reduce alcohol consumption
4) Weight loss

Question 7

WHAT IS THE PHARMACOLOGICAL MANAGEMENT FOR PUD?

Answer 7

1) PPI 4-8 weeks reassess for symptom improvement

2) H.pylori positive - triple therapy PPI + oral amoxicillin + clarithromycin/ metronidazole for 7 days

Question 8

WHAT ARE THE COMPLICATIONS OF PUD?

Answer 8

1) Perforation

2) Haemorrhage

Question 9

WHAT IS ZOLLINGER- ELLISON DISEASE?

Answer 9

• rare disorder that occurs when one or more tumours form in the pancreas and duodenum.
• tumors, called gastrinomas, release large amounts of gastrin that cause the stomach to produce large amounts of acid.

Question 10

WHAT IS THE TRIAD PRESENT IN ZOLLINGER- ELLISON SYNDROME?

Answer 10

1) severe peptic ulcer disease
2) gastric acid hypersecretion
3) gastrinoma.

Question 11

WHAT IS THE BIOCHEMICAL HALLMARK OF ZOLLINGER-ELLISON SYNDROME?

Answer 11

high fasting gastrin level