Treatment of peptic ulcers

Question 1

What is the typical presentation of a peptic ulcer?

Answer 1

Epigastric pain
Burning sensation (occurs after meals)

Question 2

What investigations should be performed if a peptic ulcer is suspected?

Answer 2

Carbon-urea breath test

Stool antigen test

Question 3

How can an infection lead to a peptic ulcer developing?

Answer 3

Helicobacter pylori (H. pylori) infection.
Urease enzyme dissolves mucus layer over epithelia, e.g. in gastric antrum.
Causes epithelial cell death- exotoxins and inflammation.
Increased acidity.
Ulceration.

Question 4

Identify the drugs used in the treatment of peptic ulcers and their mechanisms of action.

Answer 4

Antibiotics: removal of H. pylori infection.
Proton pump inhibitors, e.g. omeprazole: reduce acid production from parietal cells.
Histamine H2 antagonists: reduce acid production from parietal cells.

Question 5

Explain the underlying pathology of peptic ulcers.

Answer 5

Inhibition of protective mucus
Destruction of gastric epithelia
Increased acid production

Question 6

What can be used to treat a H. pylori positive peptic ulcer?

Answer 6

Amoxicillin and clarithromycin/metronidazole- antibiotics.

Proton pump inhibitor (PPI)- reduces acid production, 7 days.

Question 7

What can be used to treat recurrent H. pylori positive peptic ulcers?

Answer 7

Antibiotics for H. pylori (amoxicillin and clarithromycin/metronidazole).
Consider quinolone, tetracycline.
Proton pump inhibitor (omeprazole): 4-12 weeks.
Addition of bismuth.

Question 8

How can prolonged NSAID use lead to development of a peptic ulcer?

Answer 8

Directly cytotoxic.
Reduces mucus production.
Increases likelihood of bleeding.
Increased acidity.
Ulceration.

Question 9

How is a peptic ulcer caused by prolonged NSAID use treated?

Answer 9

Removal of NSAID.
Proton pump inhibitor or histamine H2 receptor antagonist (ranitidine)- 4-8 weeks.
H2 receptor increases acid secretion.

Question 10

What will the results of the carbon-urea breath test and stool antigen test be if the peptic ulcer is a result of prolonged NSAID use?

Answer 10

Both negative.

Question 11

Explain why combination treatment is the current best practice for peptic ulcers.

Answer 11

Variety of effects and improved efficacy.

Treat whole pathology of ulcer- loss of mucus and increased acid.