peptic ulcer disease Flashcards
what is peptic ulcer disease?
- includes gastric or duodenal ulceration
- a breach in the epithelium of the gastric of duodenal mucosa
main symptom of peptic ulcer disease
- upper abdominal pain
other less common symptoms of peptic ulcer disease
- nausea
- indigestion
- heartburn
- loss of appetite
- weight loss
- bloated
2 of the most common causes of peptic ulcer
- NSAID use
- H pylori infection
Life factors that can contribute to development of peptic ulcer disease
- smoking
- alcohol
- stress
H pylori infection + NSAID use
NSAIDs may have additive effect if co-existent infection, further increasing risk of peptic ulceration
Patients at high risk of developing GI complications with NSAID use
- hx complicated peptic ulcer
- or 2 or more of the following RF:
- > 65
- high dose NSAID
- other drugs that increase risk of GI adverse effects e.g. Acs, CCs, SSRIs
- serious comorbidity (e.g. CVD, hypertension, diabetes, RI or HI)
- heavy smoker
- excessive alcohol
- previous adverse reaction to NSAIDs
- prolonged use of NSAIDs
Lifestyle measures that can improve symptoms
- healthy eating
- weight loss
- avoiding trigger foods
- eating smaller meals
- eating evening meal 3-4h before bed
- raise head of bed
- smoking cessation
- reduced alcohol
- anxiety, stress, depression can exacerbate
Urgent endoscopic investigation is needed in the following pt
- dysphagia (difficulty swallowing)
- significant acute GI bleed
- 55 or over with unexplained weight loss and symptoms of upper abdominal pain, reflux or dyspepsia
Initial management of peptic ulcer disease
- review and stop any drugs that induce peptic ulcers if appropriate (NSAIDs, aspirin, bisphosphonates, immunosuppressive e.g. CC, potassium chloride, SSRIs)
- crack cocaine can also induce peptic ulcer
- test pt for H pylori - if positive and no Hx NSAID use, eradicate infection
- if associated with NSAID use, give PPI or H2RA for 8 weeks followed by eradication treatment if positive
- If negative and no Hx NSAID use, give PPI or H2RA for 4-8 weeks
Pt has a peptic ulcer and you test for H pylori. What’s the treatment if they are positive, negative, or if it is NSAID associated
- positive and no Hx NSAID use, eradication therapy
- NSAID associated, PPI or H2RA 8 weeks, followed by H pylori eradication if positive
- If negative and no hx NSAID use, give PPI or H2RA for 4-8 weeks
Follow up management for pt with peptic ulcers (gastric or duodenal) who tested positive for H pylori
- review 6-8 weeks after starting eradication treatment and re-test depending on size of lesion
- pt with gastric ulcer who tested positive for H pylori should also have repeat endoscopy 6-8 weeks after treatment to confirm ulcer healing, depending on size of lesion
Follow up management for pt with peptic ulcers (gastric or duodenal) - if the ulcer has healed, regarding NSAID treatment
- if ulcer healed and pt is to continue taking NSAIDs, discuss potential harm from NSAID treatment
- review need for NSAIDs every 6 months and use on a limited pre basis trialled
- consider reducing dose, substituting NSAID with paracetamol or using another alternative analgesic or low dose ibuprofen
Follow up management for pt with peptic ulcers (gastric or duodenal) - if pt has had previous ulceration
- If NSAID continuation necessary, or if pt is at high risk of GI SE, consider COX-2 inhibitor instead of standard NSAID
- GI protection with acid suppression therapy should always be coprescribed (PPI preferred, other options include H2RA or misoprostol but the latter has SE that limit its use)
Follow up management for pt with peptic ulcers (gastric or duodenal) - if symptoms recur after treatment
Take PPI at lowest dose possible to control symptoms
(on prn basis with pt managing their own symptoms)
