Peptic ulcer disease
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Definition
Ulcer within the stomach or duodenum.
Epidemiology
Pathophysiology
The most common cause for this is Helicobacter pylori but there are lots of other risks.
Risk Factors
- NSAIDs
- Pepsin
- Smoking
- Alcohol
- Bile acids
- Traditionally, steroids though we think this is debatable[[1]]
Clinical Features
- Most common symptom: epigastric pain, particularly after eating (postprandial). This may radiate to the back if there is a posterior ulcer
- Nausea & oral flatulence
- Symptoms relieved by antacids
Investigations
- H.pylori testing
Bloods
Imaging
Endoscopy is required in all ages if:
- Iron deficiency anaemia
- Chronic blood loss
- Progressive dysphagia
- Weight loss
- Persistent vomiting
- Epigastric mass
And required in >55yrs if: previous ulcer; previous gastric surgery; pernicious anaemia; NSAID use; family history.
Management
Behaviour modification: encourage patient to stop smoking and reduce alcohol intake.
H.pylori positive: eradication therapy is indicated.
H.pylori negative, NSAID-induced:
- Stop NSAID
- PPI for 2 monhts
H.pylori & NSAID negative:
- May require further investigation
Indication for repeat endoscopy
- Failure to eradicate symptoms in a duodenal ulcer
- Failure to eradicate H.pylori
- Gastric ulcer