Peptic Ulcer Disease

Question 1

What is PUD

Answer 1

Acid peptic injury of digestive tract resulting in defects in the mucosa that extends through the muscularis mucosae into the submucosa, often into propria are deeper. Forms sharp, punched out craters 2-4cm in diameter.

Question 2

What is the epidemiology of PUD

Answer 2

Remitting and relapsing lesions
100/100K
Duodenual ulcer - M:F 3:1
Gastric ulcer - 1:1
Lifetime prevalence is 5-10%, gastric ulcer patients are older than duodenal ulcer patients
Overall mortality is 7-10% due to ulcer bleeding

Question 3

What are the risk factors for PUD

Answer 3

1. H. Pylori infection
2. NSAID
3. Smoking
4. Zollinger ellison, peptic ulcers, stress, trauma, alcohol, corticosteroids and anticoagulants

Question 4

What is the association of H Pylori in PUD

Answer 4

50-60% of population have H pylori by 21
10-20% develop ulcer
Usually occurs on lesser curvature for gastric ulcers

Causes 85% of duodenal ulcers, and 68% of gastric ulcers

It exerts inhibitory effects on D cells leading to hypergastrinemia and acid hypersecretion

Question 5

What is the association of NSAIDs with ulcers

Answer 5

8 fold increase in duodenal ulcers
40 fold increase in gastric ulcer
Chronic use increases upper BGIT by 4x and PUD by 5x
Ulcers do not recur when NSAIDs are discontinued

Question 6

What are the locations of peptic ulcers

Answer 6

1. Duodenum (75%)
2. Stomach antrum (20%)
3. Stomach lesser curvature (H. Pylori)
4. Greater curvature (a/w malignancy)
5. Esophagus
6. Meckel’s (when it has ectopic gastric mucosa)
7. Multiple sites - zollinger ellison syndrome