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