Gastrointestinal System >
Peptic Ulcer Disease

“Ulceration in the membrane of the stomach or duodenum”

Risk Factors
  • Modifiable:
    • Medications (NSAIDs)
    • Smoking
    • Alcohol abuse
    • Stress (increases acid production)
  • Non-Modifiable:
    • H. pylori
    • Zollinger-Ellison Syndrome
Pathophysiology

Increased acid production → inflammation of the stomach or duodenal wall → impaired defences → delayed gastric emptying due to acidity…

Clinical Presentation
  • Epigastric pain related to hunger, specific foods, postprandial fullness
  • Belching, nausea, heartburn, tender epigastrium, anaemia
  • Weight gain in DU + relieved by drinking milk
  • Weight loss in GU (decreased appetite)
Investigations
  • Upper Gi endoscopy with biopsy to check for H. pylori or malignancy (repeat after 6-8w to confirm healing and exclude malignancy)
  • Test for H. pylori: C13 breath test, stool antigen, serology
Management
  • Lifestyle – Avoid NSAIDs, Alcohol, Smoking
  • H. Pylori – Triple Therapy (2xAbx eg Metronidazole, Clarithromycin) and 1 PPI
  • Drugs to relieve symptoms – Antacids, Prostaglandin Analogues, gel formers
  • Drugs to reduce acid – PPI (eg Lanzoprazole 30mg PO 4w (DU)-8w (GU))
  • Repair damage – PPI, H2 Antagonists
  • If Red flag symptoms: refer urgently
Complications
  • Perforation
  • Bleeding
  • Decreased glastric outflow
  • Malignancy

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