PUD/GERD Flashcards
What is peptic ulcer disease (PUD)?
A condition where open sores (ulcers) develop in the stomach or duodenal lining due to acid and pepsin digestion
What are the two main types of peptic ulcers?
Gastric ulcers (in the stomach) and duodenal ulcers (in the duodenum
What are common causes of PUD?
Helicobacter pylori (H. pylori) infection
Nonsteroidal anti-inflammatory drugs (NSAIDs) use
What are other risk factors for PUD?
Smoking
Alcohol consumption
Stress (exacerbates symptoms but does not directly cause ulcers)
Zollinger-Ellison syndrome (gastrin-secreting tumor)
What is the classic symptom of a peptic ulcer?
- Asymptomatic
- Dyspepsia (not gastritis)
- Ulcer complications (Bleeding, Gastric outlet obstruction, Penetration and fistulisation, Perforation)
- 46% associated with reflux symptoms
What are alarming symptoms of PUD
Hematemesis (vomiting blood)
Melena (black, tarry stools)
Unintentional weight loss
Severe, persistent pain (possible perforation)
What is the gold standard test for diagnosing PUD?
Oesophagogastroduodenoscopy (OGD) to visualize ulcers and obtain biopsy if needed. OGD is also therapeutic by clipping bleeding ulcers
What tests are used to detect H. pylori infection?
Urea breath test (non-invasive, detects active infection)
Stool antigen test (detects active infection)
Serology (antibody test) (not useful for current infection)
Biopsy (via endoscopy) (gold standard for H. pylori detection)
OGD for rapid urease test / CLO test / histology /
HP culture
What is the treatment for H. pylori-positive PUD?
Triple therapy (for 14 days):
PPI (e.g., omeprazole)
Clarithromycin
Amoxicillin (or metronidazole if allergic to penicillin)
Quadruple therapy:
Tetracycline, metronidazole, omeprazole, bismuth
What is the treatment for NSAID-induced PUD?
Stop NSAIDs (or switch to COX-2 inhibitors if necessary)
Proton pump inhibitors (PPIs) for at least 8 weeks
What is the key sign of a perforated ulcer on imaging?
Free air under the diaphragm on an upright abdominal X-ray.
What is GERD?
A chronic condition where stomach acid flows back into the esophagus, causing irritation and symptoms like heartburn.
What is the primary cause of GERD?
Weak or dysfunctional lower esophageal sphincter (LES), allowing acid reflux.
What are common risk factors for GERD?
Obesity (↑ abdominal pressure)
Hiatal hernia
Smoking
Alcohol and caffeine
Spicy/fatty foods
Pregnancy
Certain medications (e.g., NSAIDs, calcium channel blockers)
What are the hallmark symptoms of GERD?
Heartburn (worse after eating, at night, or lying down)
Regurgitation (sour/bitter taste in the mouth)
Dysphagia (difficulty swallowing)
Chronic cough or hoarseness (due to acid irritation)
What are atypical symptoms of GERD?
Globus sensation (feeling of a lump in the throat)
Asthma-like symptoms (wheezing, chronic cough)
Non-cardiac chest pain
When is endoscopy recommended in GERD?
Alarm symptoms (weight loss, dysphagia, anemia, bleeding, odynophagia, early satiety, GI bleed, iron def anemia)
Symptoms persist despite treatment
Suspected Barrett’s esophagus
What are the lifestyle modifications for GERD?
Weight loss (if overweight)
Elevating the head of the bed
Avoiding large meals before bedtime
Limiting trigger foods (spicy, acidic, caffeine, alcohol)
Quitting smoking
What are the first-line medications for GERD?
Proton pump inhibitors (PPIs) (e.g., omeprazole) or H2 blockers (e.g., ranitidine) or surface agents and alginates (eg. gaviscon) or antacids
What are potential complications of GERD?
Esophagitis (inflammation of the esophagus)
Barrett’s esophagus (pre-cancerous changes)
Esophageal strictures (narrowing, leading to dysphagia)
Esophageal adenocarcinoma
Upper GI PUD symptoms
- May describe as ‘burning’, sharp pain or non specific
- May radiate to the back (but back pain as predominant symptom is
atypical) - Usually better after food (neutralise acid)
What is Barrett’s esophagus?
A condition where chronic acid exposure causes intestinal metaplasia, increasing the risk of esophageal cancer.
What is dyspepsia?
A common symptom with an extensive differential diagnosis and a heterogeneous pathophysiology. The predominant symptoms are fullness (or bloating) after meals, early satiety (inability to finish a normal-sized meal because of postprandial discomfort), or epigastric pain (or burning) that may or may not be related to meals
Duodenal ulcer pain symptoms
- 2-5 hours after a meal when acid is secreted in absence of a food buffer
- At night (between 11pm and 2 am) when the circadian stimulation of
acid is maximal
Pyloric channel ulcers symptoms
- May have food provoked symptoms due to visceral sensitisation and
gastroduodenal dysmotility - Epigastric pain worsens with food, early satiety, fullness, nausea / vomiting
Alarm features in dyspepsia
- New onset dyspepsia > 55 years old
- Family history of upper GI cancer
- Unintended weight loss
- GI bleeding
- Progressive dysphagia
- Odynophagia
- Unexplained iron deficiency anaemia
- Persistent vomiting
- Palpable mass or lymphadenopathy
- Jaundice
What are medications to treat PUD with no alarm symptoms
– Antacids
* MMT, Magnesium carbonate, Gaviscon
– H2 antagonist (H2RA)
* Famotidine, ranitidine
– Proton Pump Inhibitors
* Omeprazole, esomeprazole (nexium), rabeprazole,
pantoprazole
– Empiric trial of HP eradication
