Peptic ulcer disease Flashcards
(7 cards)
The two main causes are
NSAIDs and H. pylori
Diagnose
H. pylori with 14C urea breath test or
serology or
gastric mucosa biopsy on gastroscopy
Treatment
Use same treatment as for GORD, i.e.:
Stage 1
- General measures, lifestyle advice
- Antacids—for symptomatic relief of mild intermittent or breakthrough symptoms; suitable for daytime relief
Stage 2
- PPI—provide more rapid healing or
- H2-receptor antagonists (8 wk course)
If H. pylori +ve :
- eradicate with combined therapy and
- confirm with urea breath test or
- repeat gastroscopy.
If H. pylori −ve : treat with full dose PPI.
Therapy to eradicate H. pylori (select from)
PPI + clarithromycin + amoxycillin
- 1 wk (90–95% success)
- A 10–14 day course improves eradication by 5%
PPI + clarithromycin + metronidazole
- 2 wks (80–85%) (if amoxyicillin unsuitable)
PPI + bismuth subcitrate + metronidazole + tetracycline
- 2 wks (for failed triple therapy)
PPI + amoxycillin + levofloxacin (for salvage therapy)
Surgical treatment
Indications include:
failed medical treatment after 1 yr
complications
- uncontrollable bleeding
- perforation
- pyloric stenosis
suspicion of malignancy in gastric ulcer
recurrent ulcer after previous surgery
NSAIDs and peptic ulcers
Ulcer identified in NSAID user
Stop NSAID (if possible)
Check smoking and alcohol use
Try alternative anti-inflammatory analgesic (e.g. paracetamol or enteric-coated, slow-release aspirin)
- H2-receptor antagonist (full dose) for 4–6 wks or
- misoprostol 800 mg/d (used for GU) or
- PPI (e.g. omeprazole 20–40 mg/d for 2–4 wks)
Prevention of ulcers in NSAID user
Try alternatives (as above).
Prophylactic drugs are rarely justified but reasonable in those:
- >75 yrs old
- with a past history of peptic ulcer.
Misoprostol (prevents GU recurrence)
H2-receptor antagonist (prevents DU, not GU)
If H. pylori is present, it should be eradicated
A useful prophylactic agent is Arthrotec 50 (diclofenac 50 mg + misoprostol 200 mg) taken orally 2–3 times/d.
