Stomach: Peptic Ulcers, GERD

Question 1

Peptic ulcers

• causes
• presentation, complications

Answer 1

HPylori
NSAIDs
Smoking, alcohol, stress
Zollinger Ellison

Indigestion, N+V, EG pain
Worsened by spicy foods
Improved with milk, alkalis

Hematemesis, melena

• shock if gastroduodenal artery affected
• endoscopy within 24hrs of bleed, PPI given if ulcer found

Question 2

Peptic ulcer

-investigations, diagnosis

Answer 2

HPylori testing

-C13 urea breath test/stool antigen

Question 3

Peptic ulcer

-management

Answer 3

Stop causative medications, avoid triggers
-PPI

HPyrlori eradication + follow up endoscopy after 6-8wks

• PPI + amoxicillin +
• clarythromycin/metronidazole

Question 4

GERD

-pathophysiology, presentation

Answer 4

Reflux of peptic juice through LES => inflammation, stricture, spasm of esophagus

• angina like pain
• indigestion
• hoarse voice, cough, acidic taste in mouth
• dysphagia

Hiatus hernia
Food triggers - coffee, alcohol, acids, spices, fatty foods
Smoking
Obesity, pregnancy
NSAIDs, bisphosphonates

Question 5

GERD

• investigations, diagnosis
• management
• complications

Answer 5

Clinical diagnosis

Lifestyle

• smaller meals, avoid triggers
• weight loss, stop smoking
• sleep at an angle

Medical
-PPI, H2 ant or alginate antacids

Surgical
-fundoplication

Barrets esophagus => esophageal cancer