Peptic Ulcer Disease

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Introduction

  • Peptic ulcers (gastric, duodenal or lower oesophagus) are defects in the gastrointestinal mucosa that extend through the muscularis mucosa

Aetiology/Predisposing factors

  • H pylori infection
  • Use of NSAIDs
  • Smoking
  • Alcohol

Clinical features

Recurrent epigastric pain

  • Often radiating to the back
  • Worse at night
  • Improved by antacids

Complications

  • Upper gastrointestinal bleeding
  • Perforation
  • Penetration
  • Gastric outlet obstruction

Investigations

  • Occult blood test
  • Stool microscopy
  • Endoscopy
  • Barium meal
  • Direct/indirect detection of H. pylori

Treatment goals

  • Relieve pain
  • Promote healing of ulcers
  • Eradicate H. pylori
  • Prevent/reduce recurrence

Drug treatment

• H. pylori eradication Triple therapy with:
- Clarithromycin 500 mg orally every 12 hours for 10 - 14 days Plus:
- Amoxicillin 1g orally every 12 hours for 10-14 days Plus:
- Omeprazole 20 mg orally every 12 hours for 10 - 14 days

- Omeprazole could be substituted with other proton pump inhibitors (PPI) e.g. rabeprazole, rantoprazole or esomeprazole.

If no improvement with the above regimen, patient should be referred to a Gastroenterologist for further evaluation and therapy

Supportive therapy

  • Regular meals
  • Avoidance of provocative factors (NSAIDs, alcohol, spicy foods etc.)

Notable adverse drug reactions, complications and caution

  • Gastric irritation, diarrhoea from triple therapy