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Peptic Ulcer Disease

In This Article

Summary

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Epidemiology

  • More common in men than women
  • DU’s and 2-3x as common as GU’s
 
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Aetiology

  • H. pylori infection
  • Smoking -reduces prostaglandin synthesis
  • Alcohol intake
  • NSAID use – reduced prostaglandin synthesis
 
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Pathology

H. pylori produces ammonia which is able to neutralise the acid around the cell, and thus enables the cell to survive in the stomach. It also likes to live in crypts just next to the acidic sensors of stomach acid, thus the normal feedback mechanisms are altered, and excess acid is produced. The bacteria causes localised inflammation, and the body’s own stomach acid can worsen the effects of the inflammation. There may often be a pan-gastritis due to excess acid.
 
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Symptoms

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General

  • Epigastric pain
  • Although vomiting is rare, it may relieve pain
  • Weight loss (patient may eat less to try and avoid pain)
  • 50% of patients are asymptomatic
  • Tiredness (anaemia)
 
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Duodenal

  • Pain may be worse at night
 
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Gastric

  • Pain tends to be worse on eating, or just before eating, when acid is produced.
 
 
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Investigations

  • Stool test – this is now the first line test. Tests for the presence of H. pylori, put PPI’s must be stopped a week before the test
  • Urea breath test – if H pylori is present, any urea ingested will be converted to ammonia and then absorbed by the body. If you label the urea with an uncommon isotope (e.g. carbon13), then you can detect the isotope in the breath of the individual. If H. pylori is not present, the urea will not be turned into ammonia, and thus will pass through the GI tract undigested, and the unusual isotope will not be detected in the breath.
  • Serum IgG – you can take a blood sample for IgG against H. pylori. Test is quite useful, but levels do not fall for many months after eradication, thus you cant use this test to see if treatment is successful.
  • Endoscopy – should be done in anyone over 55, and/or with red flag symptoms. Enable biopsy (for cancer). Also, most patients are scoped 6 weeks after treatment for ulcer to check for cancer.
  • FBC – to check for anaemia
  • Fecal occult blood – not very specific
 
 
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Treatment

PPI and antibiotic eradication therapy! Stopping smoking is also a massive factor in aiding healing of the gastric mucosa.
  • Triple therapy – this is a PPI and two AB’s, e.g.:
    • Omeprazole, metronidazole and clarithromycin – all given twice daily.
    • The antibiotics are taken for 7 days, and the PPI for a further 3-4 weeks
 
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