Treatment of peptic ulcers Flashcards
Recall the 2 main presenting features of a peptic ulcer
- Epigastric pain
2. Burning sensation after meals
Recall the 3 investigations done for peptic ulcers, and which of these is the gold standard
Gold standard = endoscopy
Carbon urea breath test
Stool-antigen test for H pylori
Describe the basis of a carbon urea breath test and the implication of a positive result
Give patient loads of unique carbon isotope-urea and if you get increased levels of specific-isotope CO2 being exhaled = positive for H pylori
How can the history differentiate between a peptic and peptic and duodenal ulcer?
Pain at meal times = peptic (gastric acid) whereas if meal relieves pain = duodenal (pyloric sphincter closure)
`What is the most common cause of peptic ulcer?
Bacterial infection with H Pylori
In around what % of the population is H pylori commensal?
50%
How does H pylori infection cause development of a peptic ulcer? (2 steps”
- It produces urease which can break down the protective mucous layer
- It releases exotoxins at the epithelium, leading to IL8 release and local inflammation
How do NSAIDS cause development of peptic ulcers?
Directly cytotoxic, reducing mucous production and causing IL8 release at epithelium
What is the first line treatment for H pylori + peptic ulcers?
Amoxycillin combined with Clarithromycin/ metronidazole, and a PPI for 7-14 days
Describe the treatment of a recurrent peptic ulcer?
- Amoxycillin, clarithromycin and metronidazole given together with quinolone
- Bismuth
- Omeprazole (PPI) for 4-12 weeks
How do PPIs reduce gastric acid secretion?
Inhibit proton pump on apical side of parietal cells
If NSAID cannot be removed, how is an NSAID-induced peptic ulcer treated?
PPI or H2 antagonist
Why would an H2 receptor antagonist be useful in peptic ulcer treatment?
H2 receptors on parietal cells stimulate proton pump to increase acid secretion
Recall the function of prostaglandins in the stomach
PROTECTIVE
- Increase blood supply to stimulate mucous production
- Increase HCO3- production
- Decrease acid production
Recall the risk factors for peptic ulcers
- Stress
- genetic
- Lifestyle (diet/ alcohol/ smoking)