Peptic Ulcers (Gastric and duodenal)

Question 1

How common are duodenal ulcers?

Answer 1

Du affects 10-15% of adults and are 2-3X more common as gastric ulcers

Question 2

What is the prevalence of H.pylori in developing vs developed countries?

Answer 2

poor countries : 80-90%

rich countries : 20-50%

Question 3

who does peptic ulcer disease affect?

Answer 3

• common in elderly
• low rates in young (but increasing in females)
• more prevalent in developing countries due to more h.pylori.

Question 4

What are the symptoms of Duodenal ulcers?

Answer 4

• epigastric pain typically before meals or at night.
• pain relieved by eating or drinking milk.
• 50% are asymptomatic, others experience recurrent symptoms.

Question 5

What are the classical symptoms of peptic ulcers?

Answer 5

• recurrent burning epigastric pain
• patient points single finger to site of pain = peptic ulcer disease.
• nausea (vomiting can relieve pain)
• anorexia / weight loss

Question 6

what is the tell tale symptoms of a penetrating posterior ulcer?

Answer 6

• back pain

Question 7

What are the signs of duodenal ulcers?

Answer 7

• epigastric tenderness

Question 8

What are the minor risk factors for DU?

Answer 8

• increased gastric secretion
• increased gastric emptying causes decreased duodenal pH
• blood group O
• smoking
• stress

Question 9

What are the differentials for DU?

Answer 9

• non ulcer dyspepsia
• duodenal crohns
• TB
• lymphoma
• ## pancreatic cancer

Question 10

What are the major risk factors for DU?

Answer 10

• h.pylori

- Drugs (NSAIDs, Steroids, SSRIs)

Question 11

What drugs increase the risk of DU?

Answer 11

• NSAIDs
• Steroids
• SSRIs

Question 12

What are the invx for DU?

Answer 12

1) Endoscopy (stop PPI 2 weeks before)
2) H.Pylori Test
3) Measure Gastrin conc (when off PPI) if Zollinger - Ellison syndrome suspected

Question 13

What is Zollinger-Ellison syndrome?

Answer 13

rare condition where tumours in pancreas and duodenum secrete gastrin.

Could be caused by MEN1 (multiple endocrine neoplasia type 1)

Question 14

What are the alarm symptoms of peptic ulcers?

Answer 14

ALARM Symptoms:
A - anaemia
L - Loss of weight
A - anorexia
R - recent onset / progressive symptoms
M - Melaena / haematemeseis
S - swallowing difficulty

Question 15

Where are Gastric ulcers more likely to occur and who do they affect?

Answer 15

• affect elderly

- location is lesser curve of stomach

Question 16

What are the risk factors for gastric ulcers?

Answer 16

• H.Pylori (80%)
• smoking
• NSAIDs
• reflux of duodenal contents
• delayed gastric emptying
• stress

Question 17

What are the symptoms of gastric ulcers?

Answer 17

• Asymptomatic
• epigastric pain (can be related to meals, can be relieved by antacids)
• can have weight loss

Question 18

What are the tests for gastric ulcers?

Answer 18

• upper GI endoscopy to exclude malignancy (stop PPI for 2 weeks before)
• multiple biopsies from rim and base
• H.Pylori histology
• brush for cytology

Question 19

What is the treatment for H.pylori eradication?

Answer 19

Triple therapy for 7 days:

• PPI, amoxicillin 1g, clarithromycin 500mg (twice daily)

OR

-PPI, metronidazole 400mg, Clarithromycin 250mg (twice daily)

Question 20

what are the drugs used to reduce acid in PU?

Answer 20

1) PPI e.g. lanzoprazole 30mg/24hrs for 4 wks (DU) or 8wks (GU)
2) H2 blockers (ranitidine 300mg every night for 8wks)

Question 21

What is the treatment for drug induced ulcers?

Answer 21

Patients on NSAIDs or Antiplatelet drugs can be treated with PPI.

Question 22

What are the differentials for dyspepsia?

Answer 22

• Non-ulcer dyspepsia
• Oesophagitis / GORD
• Duodenal / gastric ulcer
• duodenitis
• gastric maliganancy
• gastritis

Question 23

What are the complications of PU?

Answer 23

• bleeding —> iron deficiency anaemia, malaena, shock
• perforation —> peritonitis
• malignancy
• reduced gastric outflow

Question 24

what is the most accurate non invasive h.pylori test?

Answer 24

1) 13C breath test. - (95% specificity and sensitivity)

2) stool antigen
3) serology