• Peptic Ulcer Disease

    by  • 01/05/2013 • Gastroenterology • 0 Comments

    Peptic (=’acid-related’) ulcer = DU or GU or both!

    Duodenal ulcer:

      1. o Incidence: improving in line with improvements in living standards, still affects 10-15% in certain populations. Helicobacter pylori carriage and NSAIDs use are the major RFs.
    1. p/c:
      1. o Dyspepsia: abdo pain, worse at night, relived by food
      2. o Vomiting: due to oedema or stenosis of pylorus
      3. o GI bleeding: common in PU
      4. o Perforation: +peritonitis may be a complicating feature (=rigid, painful abdomen)
    2. Ix:
      1. o Endoscopy: 1st line for dyspepsia/upper GI bleeding. Can be therapeutic in bleeding with injections/banding
      2. o Testing for H.pylori: typically v difficult to culture – test via:
      3. o CLO test: for bacterial ‘urease’, from endoscopically obtained antral tissue. Urease hydrolyses ureamethane and carbon dioxide. Detected by a colour change in pH-sensitive indicators.
      4. o 13C-labelled urea breath test: radiolabelled urea is ingestedand 13CO2 is produced by hydrolysis, excreted in lungs and detected in mouth
      5. o Measurement of H.pylori antibodies in blood.
      6. o Detection of H.pylori alone is not sufficient for diagnosis of DU, because 20% (20yo) to 50% (50yo) population carry it anyway
      7. o Barium contrast radiology: less commonly used – flexi-endoscopes are preferred.

     

    Gastric ulcers:

    1. Key difference – GU’s have potential to be malignant.
    2. P/c: same as PU although often less acid involved – so less dyspepsia
    3. Ix: endoscopy – because of increased risk of cancer – biopsy ulcer edge and re-scope 6/52 later.
    4. Mx:
      1. o STOP NSAIDs!
      2. o Use H2 receptor antagonists and PPIs – should heal in 4-6/52!
      3. o H.pylori eradication:
      4. o Regimens consist of a high dose PPI + two different antibiotics. Example = one week “triple therapy” consisting of omeprazole/lansoprazole and the antibiotics clarithromycin and amoxicillin.
      5. o Regimen is usually 70% successful.
      6. o Success can be proven using 13C-radiolabelled urea breath test
      7. o Surgery: required in those with perforation and recurrent or persistent bleeding. Elective surgery is not recommended. 
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