Peptic ulcer Flashcards
What is the definition of a peptic ulcers?
Ulceration of the mucosa of the stomach/duodenum
Explain the epidemiology of peptic ulcers
Out of all the people who have endoscopy, 13% have gastric ulcers
Explain the pathology of peptic ulcers
- Parietal cell loss
- Decreased acid production
- Alteration in gastric mucosa
- Cytokine production reducing mucosal resistance
What is the aetiology/risk factors for peptic ulcers?
- H. pylori (80%)
- NSAIDs (20%)
- Smoking
- Alcohol
- Steroids
- Zollinger-Ellison syndrome
- Crohn’s disease
What are the signs and symptoms of peptic ulcers?
- Epigastric pain – recurrent burning, heaviness, ache at night
- Pain is relieved by antacids
- Nausea/vomiting – may relieve pain
- Belching
- Fullness in the upper abdomen
- Weight loss/anorexia
- Back pain – may indicate posterior penetration of ulcer
What investigations can be carried out if a peptic ulcer is suspected?
- 13C urea breath test – H. pylori
- Stool antigen test – H. pylori
- Biopsy urease test using endoscopy – false positive if patient is on antibiotics or PPI’s. Essential for those over 55 to rule out gastric cancer
- Histology – H. pylori
- Cultures – H. pylori
What are the surgical treatment options for peptic ulcers?
Only used if a recurrent problem or perforation occurs
• Partial gastrectomy – part of the stomach is removed
• Vagotomy – branch of the vagus nerve is cut to reduce gastric secretions
What are the pharmacological treatment options for peptic ulcers?
- PPI (omeprazole, lansoprazole)
- H2 antagonist (ranitidine) if no response to PPI
- Antacid/alginate – immediate relief
- H. pylori eradication therapy – Amoxicillin 1g with clarithromycin 500mg and metronidazole 400mg OR clarithromycin 250mg with metronidazole 400mg
- Alternative analgesia to NSAIDs
- Switch aspirin to clopidogrel
What are the non pharmacological treatment options for peptic ulcers?
• Smoking cessation
