Pud

1. Peptic ulcer disease
Mucosal erosion >0.5 cm
in distal esophagus,
stomach, proximal duodenum

2. Cause
Helicobacter pylori infection
Gram –ve bacilli, in antral mucosa
Responsible for ~60% stomach ulcers &
~90% doudenal ulcers
NSAIDs
Gastrinoma- Zollinger-Ellison syndrome
?Stress- burns/head injury/sepsis

3. Symptoms
Pain- epigastric/retrosternal
Association with meals- common
gastric exacerbated, duodenal
relieved

4. Complications
UGI bleeding- hematemesis/malena
Perforation- peritonitis/pancreatitis
Penetration into adjacent organs
Gastric outlet obstruction
Cancer- stomach- consider if,
symptoms in person >45 years of age
or weight loss
or greater curvature ulcer

5. Diagnosis
UGIE/EGD- to visualise ± biopsy ulcer
Dx of H. pylori infection-
Urea breath test
Stool antigen test
Blood antibody test- poor sensitivity & specificity
Urease activity in biopsy specimen
Histological examination of biopsy specimen
Staining & culture of biopsy specimen

6. Treatment
Stop NSAIDs, if necessary add PPI or Misoprostol
PPI x 4 weeks or H2RB x 6-8 weeks
heal ~90% of peptic ulcers
H. pylori Rx-
1 PPI + 2 antibiotics x 7-14 days
Clarithromycin, Amoxycillin, Metronidazole
If large ulcer, continue PPI x 4 more weeks
Recurrence ~10% in 1 year (~85%, if H. pylori untreated)
No H. pylori- long-term, higher dose PPI
Complications-
Bleeding- cautery/injection/clipping by UGIE
Others- surgery

7. Treatment
Stop NSAIDs, if necessary add PPI or Misoprostol
PPI x 4 weeks or H2RB x 6-8 weeks
heal ~90% of peptic ulcers
H. pylori Rx-
1 PPI + 2 antibiotics x 7-14 days
Clarithromycin, Amoxycillin, Metronidazole
If large ulcer, continue PPI x 4 more weeks
Recurrence ~10% in 1 year (~85%, if H. pylori untreated)
No H. pylori- long-term, higher dose PPI
Complications-
Bleeding- cautery/injection/clipping by UGIE
Others- surgery