Peptic Ulcer Disease
Ulcer: a break in an epithelial surface
Peptic ulcer: an ulcer in the digestive tract caused by digestion of the mucosa by pepsin and acid
Common: gastric ulcer, duodenal ulcer
Uncommon: oesophageal ulcer, jejunal ulcer
- Helicobacter pylori infection
- various drugs:
- NSAIDs (inhibit prostaglandin synthesis, thereby destroying mucosal defence mechanisms)
- corticosteroids (immunosuppressive)
- selective serotonin reuptake inhibitors
- physical stress e.g. neurosurgery or burns
Signs & Symptoms
- localized epigastric pain and tenderness
Gastric vs Duodenal Ulcers
|Radiation of pain||none||back|
|Timing of pain||post-prandial||- pre-prandial
|Relieving factors||antacids||- eating
- drinking milk
|Most common cause||NSAIDs||H. pylori|
|Peak age of incidence||50y||30y|
- iron deficiency anaemia
- gastric outlet obstruction (pyloric stenosis)
- oesophagoduodenogastroscopy (OGD) (upper GI endoscopy)
- barium meal if OGD contraindicated
- ulcer biopsies for histology
- ulcer brushings for cytology
- H. pylori test
- urea breath test
- biopsies from OGD
Note that there is not sufficiently strong evidence comparing surgical and medical management options
- stop smoking
- reduce alcohol intake
- reduce stress
- to reduce gastric acid secretion:
- proton pump inhibitor (PPI) e.g. omeprazole 20 mg OD
- H2 blockers e.g. ranitidine 150 mg BD
- antacid e.g. colloidal bismuth
- triple therapy for H. pylori e.g. omeprazole 20 mg + amoxicillin 1g + clarithromycin 500 mg BD for 1 week
|Type of surgery||elective||emergency|
|Procedure||highly selective vagotomy||various*|
|Indication||medical treatment not tolerated||complications|
*Haemorrhage may be controlled endoscopically by adrenaline injection, diathermy, laser coagulation or heat probe.
*Perforation may be managed medically with IV antibiotics, but most patients have reparative surgery.
*Pyloric stenosis is treated with endoscopic balloon dilatation followed by maximal acid suppression.
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- Gurusamy KS, Pallari E. Medical versus surgical treatment for refractory or recurrent peptic ulcer. Cochrane Database of Systematic Reviews 2016, Issue 3. Art. No.: CD011523. DOI: 10.1002/14651858.CD011523.pub2<http://dx.doi.org/10.1002/14651858.CD011523.pub2>