Peptic Ulcer Disease

Overview

Peptic ulcer disease involves a different part of the stomach and the duodenum. It is the discontinuity of the mucosal surface caused by local inflammation, decreased protective mucosal layer or increased stomach acidity which leads to ulcers.

Signs and Symptoms

Nausea, Vomiting, Abdominal bloating, Central abdominal pain, Pain that radiates to the back (duodenal), Pain that is relieved by food (duodenal), Pain that occurs early hours in the morning (duodenal), Pain precipitated by food (gastric), Weight loss, Bloody vomitus, Abnormal black stool

Common Causes

Helicobacter pylori infection, Drugs (NSAIDS, clopidogrel and glucocorticoids), Smoking, Alcohol misuse, Excessive caffeine intake, Poor diet, Spicy food, Psychological stress, Anxiety, Chemotherapy, Hormonal, Oral contraceptive pills

Risk Factors

Increasing age, Female, Chronic use of NSAIDS, Pregnancy

Investigation Techniques

Oesophagogastroduodenoscopy (OGDS), CLO test (biopsy urease test), Barium meal, Urease breath test, CO2 breath test, Stool antigen testing, Serology, Fasting serum gastrin levels, Erect plain chest X-ray, Serum amylase levels ( To exclude pancreatitis), Serum lipase, Liver transaminase levels, Full blood test

Treatment and Prevention

Control of predisposing factor using triple therapy. Triple therapy consist of 1-2 weeks of 2 antibiotics (amoxicillin 1g BD and clarithromycin 500mg BD) with proton pump inhibitor, Diminish irritant effects of acid-pepsin using antacid or alginate preparation, Mucosal protective agents using sucralfate, Reduction of acid secretion using proton pump inhibitor or H2 blocking drugs.