Treatment of Gastric and Duodenal Ulcers

Question 1

Virulence of H. Pylori in peptic ulcers (3)

Answer 1

Increases gastric acid formation – increases gastrin production and reduces somatostatin.
Causes gastric metaplasia – cell transformation due to excessive acid exposure and so increases likelihood of getting more damaging peptic ulcers.
Downregulation of defense factors – reduces epidermal GF (leads to less epithelium production) decreases bicarbonate production (increases acidity of the environment

Question 2

Pathophysiology of H. Pylori mediated peptic ulcers

Answer 2

Dissolves mucus layer, so there’s less protection for the epithelium : urease enzyme
Causes epithelial cell death: exotoxins & inflammation
Increased acidity -> peptic ulcer

Question 3

Treatment for uncomplicated helicobacter pylori mediated peptic ulcers?

Answer 3

Antibiotics (amoxicillin and Clarithromycin/Metronidazole)

And proton pump inhibitor to reduce acid secretion

Question 4

Treatment for complicated helicobacter pylori mediated peptic ulcers?

Answer 4

• Antibiotics for H Pylori (amoxicillin & clarithromycin/metronidazole)
• Consider quinolone, tetracycline as this is complicated
  Proton Pump Inhibitor (omeprazole) – 4-12 weeks

Question 5

Example of a PPI?

Answer 5

Omeprazole

Question 6

Omeprazole is an example of…?

Answer 6

PPI

Question 7

Treatment for NSAID mediated peptic ulcer? (3)

Answer 7

• Removal of NSAID
• Proton Pump Inhibitor or histamine H2 receptor antagonist (Ranitidine) – 4-8 weeks
• H2 receptor increases acid secretion from parietal cells

Question 8

Symptoms of a peptic ulcer?

Answer 8

Epigastric pain and burning sensation

Question 9

Tests to be taken when suspicious of peptic ulcers (3)

Answer 9

Carbon-urea breath test
Stool antigen test
Check NSAID use