Peptic Ulcer

Peptic ulcer disease (PUD) is condition in which there a break in the inner lining of the stomach (gastric ulcer) or the first part of the small intestine (duodenal ulcer). Affects around 4-5% of the population.

The diet does not appear to play any significant role in the cause and treatment of peptic ulcers. Chronic life stresses were once considered as the cause, prior to the identification in 1982 of Helicobacter pylori as the most common cause.

Most common cause is the bacterium Helicobacter pylori.
Next most common cause is the long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs)
Less common causes: other medications (eg corticosteroids, bisphosphonates); viral infection; radiation therapy; Crohn disease; chemotherapy.
Smoking and alcohol consumption can also play a role and increase the risk.

Clinical Features:
The most frequent symptoms are a burning stomach pain; a feeling of fullness, bloating or belching; heartburn; nausea – usually within 15-30 minutes after a meal in patients for a gastric ulcer and 2-3 hours after for a duodenal ulcer.
More severe and less common symptoms: vomiting; vomiting blood; dark blood in stools; shortness of breath; feeling faint; appetite changes

Diagnosis: characteristic symptoms; lab tests for Helicobacter pylori; endoscopy (considered ‘gold standard’); imaging (barium swallow).

Differential diagnosis: gastritis; stomach cancer; gastroesophageal reflux disease; pancreatitis; cholecystitis; myocardial infarction (inferior wall); referred pain (eg from pleurisy)

Complications and Consequences:
Internal bleeding; Gastric outlet obstruction; Perforation; Increased risk for stomach cancer; Iron deficiency anemia

Combination of antibiotics for 7-10 days for Helicobacter pylori (clarithromycin, metronidazole, amoxicillin); antibiotic resistance is becoming a problem.
Cease NSAIDs (typically heal in 6-8 weeks after cessation).
Histamine (H2) blockers (eg cimetidine) or proton pump inhibitor (eg omeprazole, pantoprazole) (decreases gastric acid production).
Surgical treatment if refractory.

Proton pump inhibitors can be used if someone at risk needs to take NSAID’s

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