Peptic Ulcer

Question 1

Description: State the two types of peptic ulcer.

Answer 1

• Gastric ulcer

- Duodenal ulcer (more common)

Question 2

Aetiology: State the causes of peptic ulcer under the following categories:

(a) Most common cause
(b) Other causes
(c) Rare causes

Answer 2

(a) H.pylori
(b) NSAIDs and smoking
(c) Crohn’s disease, hyperparathyroidism and Zollinger-Ellison syndrome

Question 3

Pathology:

(a) Why do peptic ulcers occur
(b) What structures in the GI tract are affected by peptic ulceration

Answer 3

(a) There is an imbalance between acid secretion and mucosal barrier
(b) Lower oesophagus, body and antrum of the stomach AND 1st and 2nd parts of the duodenum

Question 4

Symptoms: State the symptoms of peptic ulcers (6)

Answer 4

• Epigastric pain
• Nocturnal/hunger pain
• Back pain
• Nausea and occasional vomiting
• Weight loss and anorexia
• Haematemesis/melaena (if ulcer bleeds)

Question 5

Signs: State the signs of peptic ulcers (1)

Answer 5

• Epigastric tenderness

Question 6

Investigations: What investigation do we do for peptic ulcers:

(a) Non-invasive tests
(b) Invasive tests

Answer 6

(a) Non-invasive
- Stool antigen test (ELISA) – you need to be off protein pump inhibitors for 2 weeks
- 13C/14C urea breath test
- Serology (IgG against H.pylori)
(b) Invasive

Requires endoscopy:

• Histology
• Culture
• Rapid slide urease test (CLO)

Question 7

Treatment: How do we treat the different caused of peptic ulcers?

Answer 7

Treat the causes as follows

Ulcer caused by H.pylori, then treat by eradication therapy to get rid of bacteria.
H.pylori eradication triple therapy for 7 DAYS includes:
- Clarithromycin 500 mg twice a day
- Amoxycillin 1g twice a day
- Proton pump inhibitor (e.g omeprazole 20 mg twice a day)

Antacid medication to lower acid secretion:

• Proton pump inhibitors (omeprazole)
• Hydrogen receptor blockers (ranitidine)

Stop NSAIDs if being used

Question 8

Complications: What are the complications of peptic ulcers?

Answer 8

• Acute bleeding
• Chronic bleeding
• Perforation
• Fibrotic stricture
• Gastric outlet obstruction

Surgery may be indicated here

Question 9

Extra: (not in the lecture but) Why do NSAIDs cause peptic ulcer?

Answer 9

NSAIDs inhibit prostaglandin formation and so reduce the ability of the stomach to heal itself