Peptic Ulcer Disease And Gastritis

Question 1

Define Peptic Ulcer Disease and Gastritis?

Answer 1

Ulceration of areas of the GI tract caused by exposure to gastric acid and pepsin
Peptic Ulcers are more commonly gastric and duodenal (but they can also occur in the oesophagus and Meckel’s diverticulum)

Question 2

What is the aetiology of Peptic Ulcer Disease and Gastritis?

Answer 2

Caused by imbalance between the damaging action of acid and pepsin penis and the mucosal protective mechanisms
There is a strong correlation with H.Pylori

Question 3

What are the common causes of Peptic Ulcer Disease and Gastritis?

Answer 3

H. Pylori

NSAIDs

Question 4

What is a Rare cause of Peptic Ulcer Disease and Gastritis?

Answer 4

Zollinger-Ellison Syndrome

Question 5

What is Zollinger-Ellison Syndrome?

Answer 5

A condition in which a gastrin-secreting tumour or hyperplasia of the islet cells in the pancreas cause overproduction of gastric acid, resulting in recurrent peptic ulcers

Question 6

What is the epidemiology of Peptic Ulcer Disease and Gastritis?

Answer 6

COMMON
Annual incidence: 1-4/1000
More common in males
Mean age: 
Duodenal Ulcer: 30s 
Gastric Ulcers: 50s 
H.Pylori is usually acquired in childhood and prevalence is roughly equal to age in years

Question 7

What are the presenting symptoms of Peptic Ulcer Disease and Gastritis?

Answer 7

Epigastric pain
Relieved by antacids
Patients may present with complications e.g. haematemesis, melaena

Question 8

What is the relationship between symptoms of Peptic Ulcer Disease and Gastritis and food intake?

Answer 8

Gastric - pain is worse soon after eating

Duodenal - pain is worse several hours after eating

Question 9

What are the signs of Peptic Ulcer Disease and Gastritis on physical examination?

Answer 9

There may be NO physical findings
Epigastric tenderness
Signs of complications e.g. anaemia

Question 10

What bloods would you do for Peptic Ulcer Disease and Gastritis?

Answer 10

FBC 
Serum Amylase 
U&Es 
Clotting screen 
LFT 
Cross-match 
Secretin test

Question 11

Why do we do a FBC for Peptic Ulcer Disease and Gastritis?

Answer 11

For anaemia

Question 12

Why do we do Serum Amylase for Peptic Ulcer Disease and Gastritis?

Answer 12

To exclude pancreatitis

Question 13

When do we do a Cross-Match in Peptic Ulcer Disease and Gastritis?

Answer 13

If active bleeding

Question 14

When do we do a Secretin test for Peptic Ulcer Disease and Gastritis?

Answer 14

If Zollinger-Ellison syndrome suspected

Question 15

How does the Secretin Test work?

Answer 15

IV secretin causes a rise in serum gastrin in ZE patients but not in normal patients

Question 16

Why do we do Endoscopy for Peptic Ulcer Disease and Gastritis?

Answer 16

Biopsies of gastric ulcers can be taken to rule out malignancy
Duodenal ulcers don’t need to be biopsied

Question 17

What is the Rockall Scoring?

Answer 17

Scores the severity after a GI bleed

Question 18

How does Rockall scoring work?

Answer 18

Score < 3 carries good prognosis

Score > 8 carries high risk of mortality

Question 19

What are the three ways of testing H. Pylori?

Answer 19

C13-urea breath test
Serology
Campylobacter-like organism (CLO) test

Question 20

How does the C13-urea breath test work?

Answer 20

Radio-labelled urea is given by mouth

C13 is detected in the expelled air

Question 21

How can we use Serology to test for H.Pylori?

Answer 21

IgG antibody against H.Pylori confirms exposure to H.Pylori but NOT eradication

Question 22

What is the Campylobacter-like organism (CLO) test?

Answer 22

Gastric biopsy is placed with a substrate of urea and a pH indicator
If H.Pylori is present, ammonia is produced from the urea and there is a colour change from yellow to red

Question 23

What is the acute management plan for Peptic Ulcer Disease and Gastritis?

Answer 23

Fluid resuscitation needed if the ulcer is perforated or bleeding (IV colloids/crystalloids)
Close monitoring of vital signs
Endoscopy
Surgical treatment

Question 24

How should patients with upper GI bleeding be treated?

Answer 24

IV PPIs at presentation until the cause of bleeding is identified

Question 25

How can Endoscopy be used to manage Peptic Ulcer Disease and Gastritis?

Answer 25

IF the ulcer is bleeding, haemostasis can be achieved with:

• Injection sclerotherapy
• Laser coagulation
• Electrocoagulation

Question 26

When do we perform surgery for Peptic Ulcer Disease and Gastritis?

Answer 26

Indicated if the ulcer has perforated or if the bleeding ulcer can’t be controlled

Question 27

How do we eradicate H.Pylori in Peptic Ulcer Disease and Gastritis?

Answer 27

Triple therapy for 1-2 weeks
Various combinations may be recommended - usually a combination of 2 antibiotics + PPI (e.g. clarithromycin + amoxicillin + omeprazole)

Question 28

What do we do if Peptic Ulcer Disease is not associated with H.Pylori?

Answer 28

Treat with PPIs or H2 antagonists
Stop NSAID use
Use misoprostal (prostoglandin E1analogue) if NSAID use is necessary

Question 29

What is the rate of major complications of Peptic Ulcer Disease and Gastritis?

Answer 29

1% per year

Question 30

What are the major complications of Peptic Ulcer Disease and Gastritis?

Answer 30

Haemorrhage (haematemesis, melaena, iron-deficiency anaemia)
Perforation
Obstruction/pyloric stenosis (due to scarring, penetration, pancreatitis)

Question 31

What is the prognosis for patients with Peptic Ulcer Disease and Gastritis?

Answer 31

Overall lifetime risk = 10%

Outlook is generally good because peptic ulcers associated with H.Pylori can be cured by eradication