Peptic ulcer disease and gastritis

Question 1

Define Peptic ulcer disease and gastritis

Answer 1

peptic ulcer-5mm break in lining of stomach or duodenum, depth through the mucosa, not submucosa
Gastritis-inflammation of the stomach lining, often because of H pylori/NSAIDS. Erosive gastritis-smaller ulcers, not big enough to be considered ulcer. Non erosive-chronic

Question 2

Aetiology and risk factors of Peptic ulcer disease and gastritis

Answer 2

The most common causes for all of these are-H.pylori infections and NSAID
rare causes include stress
usually due to imbalance between acid production and mucosal lining protection
H.pylori cause hypersecretion (by decreasing somatostatin/gastrin) of acid in duodenum which causes ulcer
but causes reducing of mucosa (and normal acid) in gastric ulcers
NSAID’s cause damage directly by trapping H ions and reducing COX enzymes-decrease lining
Autoimmune gastritis exists-damage to parietal cells
GASTRITIS often seen as stage before ulcers

Risk factors:
Chronic use of NSAIDs
H.pylori
Smoking
Age gastric-60-70, duodenal-40-50
Previous Hx of ulcers

Question 3

Epidiemology of Peptic ulcer disease and gastritis

Answer 3

Ulcers are very common-main cause of dyspepsia in UK by far
Duodenal ulcers are much more common than gastric (80%-20%)
HPylori on the decline, and NSAID related on the rise, in the west

Question 4

Signs and Sx of Peptic ulcer disease and gastritis

Answer 4

Duodenal-Dyspepsia especially AFTER meals, better during
Gastric-dyspepsia during meals, better after
Gastritis-dyspepsia worse with meals
always centre of epigastric

can have nausea and vom, better when eating

NO SIGNS OF MALIGNANCY

bad-upper gi bleed

can have Sx of aneamia as the ulcer bleed
Malena

Question 5

Investigations of Peptic ulcer disease and gastritis

Answer 5

FBC-aneamia (if older patient-OGD needed)
PPI trial therapy-if responds most likely
If significant bleed-OGD
OGD is gold standard diagnostic

Urea breath test
H.pylori stool test (need to stop PPI 2 weeks before those)-so care not to do trial PPI first

Question 6

Management of Peptic ulcer disease and gastritis

Answer 6

NSAID ulcers/gastritis-if Pylori negative-add PPI to NSAID, or stop NSAID if not getting better
2nd line H2 antagonist (famotidine)

H.pylori related
Triple therapy
PPI BD (normally OD)
Amoxicillin
then either clarythromycin or metronidazole

Question 7

Complications of Peptic ulcer disease and gastritis

Answer 7

Ulcers-bleeds-chronic aneamia

Chronic-penetration-can go full depth and leak into other organ (pancreas)-might need surgery

Perforation-penetrate into peritoneum-shock and peritonitis

Gastric stenosis-Obstruction

Upper GI bleeds-life threatening

gastric cancer-H.pylori is main risk factor of adenocarcinoma

gastritis risks ulcers

Question 8

Prognosis of Peptic ulcer disease and gastritis

Answer 8

With triple therapy -Ulcers heal within 4-8 weeks usually
but recurrence can be 20%
NSAID related-stopping the NSAID always does the trick

Erosive and Pylori gastritis also have good prognosis