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