Peptic Ulcer/H.pylori

Question 1

Symptoms of peptic ulcer/H.pulori

Answer 1

Upper abdominal discomfort, nausea
, bloating, fullness, early satiety
Dyspepsia (chronic or recurrent pain or discomfort centered in upper abdomen), heartburn, hematemesis, melena

*if predominantly heartburn
/acid regurgitation—> GERD till proven otherwise.

Question 2

Dyspepsia can be a sign of?

Answer 2

GERD
Cancer og stomach
Pancreatique pathology
Gallstones

Question 3

Precipitating factors for ulcer

Answer 3

Dietary: caffeine, high fat, excessive alcohol and smoking
NSAID and ASA use
Prescription meds: Calcium channel blockers, bisphophonate)

Question 4

Diagnosis of H pylori

Answer 4

Urea breath test
Blood test - how ever only useful if no past Hx of H.pylori. If test negative not likely to be h. Pylori if positive unsure the infection is now or old.

Question 5

When to do gastroscopi?

Answer 5

Only when red flags:
Vomiting
Bleeding/anemia
Abdominal mass (check for lymphoma too)
Dysphagia
Family history of GI cancer
Previous documented peptic ulcer

Question 6

Name 2 medications that are effective in preventing peptic ulcers in patients taking NsAID

Answer 6

H2 blockers
PPIs

Question 7

Lifestyle modifications in pt w peptic ulcers

Answer 7

Eat small frequent meals
Stop smoking
Reduce alcohol/caffeine, avoid irritating food
Mainstain an ideal weight

Question 8

Peptic ulcer treatment if H.pylori negative

Answer 8

PPI or H2 blockers x 4 weeks
Then reassess
If successful stop treatment, if partial repeat treatment. If failure consider investigating/referral

Question 9

Peptic ulcer treatment if H.pylori positive

Answer 9

Amoxicillin, clarithromycin and metronidazole + PPI

Urea breath test 30 days after treatment to see if cured