Peptic Ulcer Disease and Gastritis

Question 1

Define peptic ulcer disease

Answer 1

Ulceration of the gastric or duodenal mucosa resulting from the imbalance between factors
promoting mucosal damage (gastric acid, pepsin, H. pylori, NSAIDs) and factors protecting
the mucosa (prostaglandins, mucus, bicarbonate, mucosal blood flow).

Question 2

Define gastritis

Answer 2

A histological diagnosis of inflammation of the gastric mucosa

Question 3

What are the causes/risk factors of peptic ulcer disease?

Answer 3

Causes:
• H. pylori infection (95% duodenal
ulcers; 70-80% gastric ulcers)
• NSAID use (gastric ulcers)
• Zollinger-Ellison syndrome
(gastric acid neuroendocrine
tumour)
• Crohn’s disease

Risk factors:
• H. pylori infection
• NSAID use
• Smoking
• Age
• Family history

Question 4

What are the causes/risk factors of gastritis?

Answer 4

Causes:
• H. pylori infection (80%)
• Autoimmune gastritis (5%) –
atrophic gastritis and loss of
parietal cells -> achlorhydria and
pernicious anaemia

Risk factors:
• H. pylori infection
• NSAID use
• Alcohol
• Autoimmune disease

Question 5

What are the symptoms of peptic ulcer disease and gastritis?

Answer 5

• Dyspepsia
• Heartburn
• Epigastric pain
- Pain on eating – ?gastric ulcer
- Pain before eating (when hungry, at night) - ?duodenal ulcer

Symptoms of anaemia
• Fatigue

GI bleeding complications
• Melaena
• Haematemesis

Question 6

What are the signs of peptic ulcer disease and gastritis?

Answer 6

• Epigastric tenderness

Signs of anaemia
• Koilonychia
• Conjunctival pallor

Question 7

What investigations are carried out for peptic ulcer disease and gastritis?

Answer 7

Bloods
• FBC – if clinically anaemic or GI bleeding
• Amylase – exclude pancreatitis
• Clotting screen and cross-match if bleeding
• Secretin test – if Zollinger-Ellison syndrome suspected; IV secretin -> increase in
serum gastrin
• Serum B12, parietal cell antibodies, intrinsic factor antibodies – exclude autoimmune
gastritis/pernicious anaemia

Patients with no alarm features or <55 years:
H. pylori tests
• H. pylori breath test – bacteria break
down radiolabelled urea -> ammonia +
13CO2 using urease enzyme
• H. pylori stool antigen (CLO) test –
reduced sensitivity in patients taking PPIs
(stop PPIs 2-4 weeks before test)
• H. pylori serology – detects IgG; less
sensitive but may be useful in patients
taking PPIs

Patients with alarm features or >55 years:
Endoscopy
• Four quadrant gastric biopsies to exclude malignancy

Question 8

What is the management for peptic ulcer disease and gastritis?

Answer 8

Eradication therapy for 7 or 14days e.g. OCA
• Omeprazole 20mg BD
• Clarithromycin 500mg BD
• Amoxicillin 1g BD or Metronidazole 500mg BD

Acid suppression
• PPI e.g. omeprazole
• H2 antagonist e.g. ranitidine
• Stop NSAIDs or use prostaglandin E1 analogue e.g. misoprostol if NSAIDs are
necessary

Autoimmune gastritis
• IM cyanocobalamin (vitamin B12)

Question 9

What are the complications of peptic ulcer disease and gastritis?

Answer 9

• Haemorrhage
- Haematemesis
- Melaena
- Iron deficiency anaemia
• Perforation
• Gastric outlet obstruction (due to oedema, scarring , malignancy, pancreatitis)
• Gastric carcinoma (risk is increased with untreated H. pylori gastritis)