Peptic ulcer disease

Question 1

what are risk factors for peptic ulcer disease?

Answer 1

helicobacter pylori
drugs - NSAIDS, SSRI’s, bisphosphonates, steroids
alcohol
smoking
zollinger-ellison syndrome (increase in gastrin production)

Question 2

describe the presentation of a peptic ulcer.

Answer 2

typically burning epigastric pain / ache
made worse by eating (gastric)
made better by eating (duodenal)

Question 3

what 1st line investigation would you carry out if a patient presented with symptoms suggestive of a peptic ulcer?

Answer 3

helicobacter pylori test

• urea breath test or
• stool antigen test

Question 4

describe the management of peptic ulcer disease.

Answer 4

if H.pylori positive = eradication therapy

• 7 day course of PPI + amoxicillin/ metronidazole + clarithromycin
• if associated with NSAIDS + h.pylori positive then give PPI or H2 antagonist for 8 weeks followed by eradication therapy

if H.pylori negative
- PPI or H2 receptor antagonist until ulcer resolved

Question 5

what are possible complications of peptic ulcers?

Answer 5

gastritis 
rupture = peritonitis 
upper GI haemorrhage 
gastric cancer
gastric outlet obstruction

Question 6

how would you treat an upper GI haemorrhage caused by suspected peptic ulcer?

Answer 6

1st line: stabilise patient

then;

• combination of adrenaline injection + either thermal or mechanical therapy via endoscopy
• PPI 80mg bolus followed by 8mg/hr IV for 72 hours (prior to endoscopy)

if endoscopy fails then surgery or interventional angiography transarterial embolisation

surgery

• gastric: under running of ulcer, partial gastrectomy if lesser curve or antrum
• duodenum: laparotomy, duodenostomy and running of the ulcer