peptic ulcer disease
| Etiology | Helicobacter pylori, NSAIDs are the main ones Weird and wonderful: stress ulcers, autoimmune, gastrinoma |
| Epidemiology | |
| Clinical presentation | Complications: haemorrhage, gastric outlet obstruction, perforation |
| Pathogenesis | H pylori pathogenicity: - burrows through mucosal barrier - releases ammonium |
| Diagnostic investigations | To confirm H pylori: carbon-13 urea breath test or stool antigen test (after no PPI for 2 weeks, or antibiotics for 4 weeks) |
| Management | - H pylori +ve and no NSAIDs: Eradication therapy - H pylori +ve and NSAID use: full dose PPI then eradication therapy - Confirmed gastric ulcer: Repeat endoscopy and H pylori re-testing 6-8 weeks after starting treatment - Expect healing in: >> 4/52 for duodenal ulcers >> 8/52 for gastric ulcers |
Most common site of perforation: 1st part of duodenum
Most common site of significant bleeding: posterior wall of the 1st part of duodenum where ulcer erodes gastroduodenal artery