Peptic ulcers

Question 1

What is H. pylori?

Answer 1

commensal bacteria in stomach in 50% of people –> 50% will develop symptoms –> 30% of those will develop peptic ulcer

Question 2

How does a peptic ulcer present?

Answer 2

epigastric pain

birning sensation after meals

Question 3

What tests would you do for suspected peptic ulcer, and what would the results be if it was H. pylori +ve?

Answer 3

carbon-urea breath test –> +
stool antigen test –> +
= H. pylori positive peptic ulcer

Question 4

Outline the mechanism of H. pylori peptic ulcers

Answer 4

urease enzyme dissolves mucus layer –> increase exotoxins + inflammation –> epithelial cell death –> increased acidity –> peptic ulcer

Question 5

How do you treat an uncomplicated H. pylori peptic ulcer?

Answer 5

antibiotics eg. amoxicillin + clarythromyocin/metronidazole
PPIs eg. omeprazole –> decreases acid production
+ bismuth

Question 6

How do you treat a complicated H. pylori peptic ulcer?

Answer 6

same as uncomplicated + add tetracyclines/quinilones

PPI for 4-12 weeks

Question 7

Outline the NSAID induced peptic ulcer mechanism

Answer 7

NSAIDS = directly cytotoxic, increase bleeding + decrease mucus production –> increase acidity –> peptic ulcer

Question 8

What tests would you do for suspected peptic ulcer, and what would the results be if it was NSAID induced?

Answer 8

carbon-urea breath test –> -
stool antigen test –> -
NSAID use –> +

Question 9

How do you treat an NSAID induced peptic ulcer?

Answer 9

remove NSAID
PPIs
Histamine H2 receptor antagonist eg. Ranitidine –> decreases acid secretion