Peptic ulcer disease & gastritis

Question 1

Define peptic ulcer disease

Answer 1

Ulceration of areas of the GI tract caused by exposure to gastric acid & pepsin

Question 2

Locations of ulcers

2 common + 2 other

Answer 2

Gastric & duodenal

Can also occur in oesophagus & Meckel’s diverticulum

Question 3

Aetiology of peptic ulcer disease

Answer 3

Caused by an imbalance between the damaging action of acid/pepsin & the mucosal protective mechanisms

Question 4

Causes of peptic ulcers

2 + rare

Answer 4

Helicobacter pylori
NSAIDs

Zollinger-Ellison syndrome

Question 5

Epidemiology of peptic ulcer disease

prevalence, gender, ages x2

Answer 5

Common
More common in males

Mean age:
Duodenal ulcers - 30s
Gastric ulcers - 50s

Question 6

Presenting symptoms of peptic ulcer disease

2.5

Answer 6

Epigastric pain
Relieved by antacids

May present with complications (e.e. haematemesis, melaena)

Question 7

Relationship of symptoms to food intake - gastric & duodenal ulcers

Answer 7

Gastric - pain worse soon after eating

Duodenal - pain is worse several hours after eating

Question 8

Signs of peptic ulcer disease on physical examination

1 + 2

Answer 8

May be NO physical findings

Epigastric tenderness
Signs of complications (e.g. anaemia)

Question 9

Investigations for peptic ulcer disease

4

Answer 9

Bloods
Endoscopy
Testing for H. pylori
Rockall scoring

Question 10

Blood tests for peptic ulcer disease

7

Answer 10

FBC
Serum amylase
U&Es
Clotting screen
LFT
Cross match if active bleeding 
Secretin test (if Zollinger-Ellison syndrome suspected)

Question 11

Reason for endoscopy

1 + 1

Answer 11

To take biopsies of gastric ulcers to rule out malignancy

Duodenal ulcers do NOT need to be biopsied

Question 12

Definition of Rockall scoring & meaning

Answer 12

Scores the severity after a GI bleed

<3 is good prognosis, >8 is hight risk of mortality

Question 13

H. pylori tests

3

Answer 13

C13-urea breath test

Serology (IgG antibody)

Campylobacter-like organism (CLO) test

Question 14

Management of peptic ulcers

4

Answer 14

Acute
Endoscopy
Surgery
H. pylori eradication

Question 15

Management of peptic ulcers - ACUTE

4

Answer 15

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

Question 16

Management of peptic ulcers - ENDOSCOPY

3

Answer 16

If ulcer is bleeding, haemostasis can be achieved by:

• injection sclerotherapy
• laser coagulation
• electrocoagulation

Question 17

Management of peptic ulcers - SURGERY

1

Answer 17

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

Question 18

Management of peptic ulcers - H. PYLORI

2 + 3

Answer 18

H. pylori eradication
Triple therapy for 1-2 weeks
Usually 2 antibiotics + PPI (e.g. clarithromycin + amoxicillin + omeprazole)

If peptic ulcer is NOT associated with H. pylori:
Treat with PPIs or H2 antagonists
Stop NSAID use
Use misoprostol if NSAID use necessary

Question 19

Major complications of peptic ulcer disease

% annually + 3

Answer 19

1% major complications per year

Major complications -
Haemorrhage
Perforation
Obstruction/pyloric stenosis

Question 20

Prognosis for peptic ulcer disease

2

Answer 20

10% overall lifetime risk

Generally good as H. pylori can be cured by eradication