Peptic Ulcer Disease & Gastritis Flashcards
Definition
Ulceration of areas of the GI tract caused by exposure to gastric acid and pepsin. Peptic
ulcers are most commonly gastric and duodenal (but they can also occur in the
oesophagus and Meckel’s diverticulum).
Aetiology
• Caused by an imbalance between the damaging action of acid and pepsin and
the mucosal protective mechanisms
• There is a strong correlation with Helicobacter pylori
Causes
• COMMON CAUSES of peptic ulcer disease and gastritis:
o Helicobacter pylori
o NSAIDs
• RARE cause: Zollinger-Ellison syndrome (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)
Epidemiology
- COMMON
- Annual incidence: 1-4/1000
- More common in males
• Mean age:
o Duodenal ulcer: 30s
o Gastric ulcers: 50s
• Helicobacter pylori is usually acquired in childhood and prevalence is roughly equal to
age in years
Presenting symptoms
- Epigastric pain
- Relieved by antacids
• Symptoms have a variable relationship to food intake:
o Gastric - pain is worse soon after eating
o Duodenal - pain is worse several hours after eating
• Patients may present with complications e.g. haematemesis, melaena
Signs on physical examination
- There may be NO physical findings
- Epigastric tenderness
- Signs of complications e.g. anaemia
Investigations (bloods)
o FBC (for anaemia)
o Serum amylase (to exclude pancreatitis)
o U&Es
o Clotting screen
o LFT
o Cross-match if active bleeding
o Secretin test (if Zollinger-Ellison syndrome suspected) - IV secretin causes a rise
in serum gastrin in ZE patients but not in normal patients)
Investigations (endoscopy)
o Biopsies of gastric ulcers can be taken to rule out malignancy
o Duodenal ulcers do NOT need to be biopsied
Investigations (Rockall scoring)
o Scores the severity after a GI bleed
o Score < 3 carries good prognosis
o Score > 8 carries high risk of mortality
Investigations (testing for H. pylori)
o C13-urea breath test :
• Radio-labelled urea is given by mouth
• C13 is detected in the expelled air
o Serology:
• IgG antibody against H. pylori confirms exposure to H. pylori but NOT
eradication
o Campylobacter-like organism (CLO) test:
• 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
Management plan (acute)
o Fluid resuscitation needed if the ulcer is perforated or bleeding (IV colloids/crystalloids) o Close monitoring of vital signs o Endoscopy o Surgical treatment
o NOTE: patients with upper GI bleeding should be treated with IV PPIs at
presentation until the cause of bleeding is identified
Management plan (endoscopy)
If the ulcer is bleeding, haemostasis can be achieved with:
· Injection sclerotherapy
· Laser coagulation
· Electrocoagulation
Management plan (surgery)
o Indicated if the ulcer has perforated or if the bleeding ulcer can’t be controlled
Management plan (H. pylori eradication)
o Triple therapy for 1-2 weeks
o Various combinations may be recommended - usually a combination of 2
antibiotics + PPI (e.g. clarithromycin + amoxicillin + omeprazole)
Management plan (if disease not associated with H.pylori)
o Treat with PPIs or H2 antagonists
o Stop NSAID use
o Use misoprostol (prostoglandin E1 analogue) if NSAID use is necessary
