Peptic Ulcer Disease (PUD)
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Ulceration of gastro-duodenal mucosa. It tends to be chronic and recurrent if untreated.
Cause
- Helicobacter pylori infection
Hyperacidity due to:
- Drugs (NSAIDS e.g. acetylsalicylic acid, corticosteroids)
- Irregular meals
- Stress
- Alcohol and smoking
- Caffeine-containing beverages
Clinical features
- General
- Epigastric pain typically worse at night and when hungry (duodenal ulcer) alleviated by food, milk, or antacid medication
- Epigastric pain, worse with food (gastric ulcer)
- Vomiting, nausea, regurgitation
- Discomfort on palpation of the upper abdomen
- Bleeding ulcer
- Haematemesis (coffee brown or red vomitus)
- Black stools (i.e. melena)
- Sudden weakness and dizziness
- Cold, clammy skin (when patient has lost a lot of blood)
- Perforated ulcer
- Acute abdominal pain, signs of peritonitis such as rigid abdomen
- Ground coffee-brown vomitus (due to blood)
- Fever
- Shock (weak pulse, clammy skin, low blood pressure)
Differential diagnosis
- Pancreatitis, hepatitis
- Disease of aorta, myocardial infarction
- Lung disease (haemoptysis)
Investigations
- Positive stool antigen for H. pylori. Used for diagnosis and to confirm eradication.
- This test may give false negative if the patient has been taking antibiotics or omeprazole in the previous 2 weeks
SERUM ANTIBODY TEST IS NOT USEFUL FOR DIAGNOSIS AND FOLLOW UP
- Gastroscopy
- Biopsy of stomach wall
- Barium meal
Management and Prevention
Treatment
Modify diet: avoid precipitating causes and increase milk intake
- Give an antacid
- Magnesium trisilicate compound 2 tablets every 8 hours as required
Treatment for eradication of H. pylori (Triple therapy)
Combination 1 (First line)
- Amoxycillin 1 g every 12 hours PLUS metronidazole 400 mg every 12 hours PLUS omeprazole 20 mg every 12 hours for two weeks
- Check eradication with a stool antigen test after 4 weeks
For bleeding and perforated ulcer
- Refer patient to hospital immediately for
- IV fluids and blood if necessary
- IV ranitidine 50 mg in 20 ml slowly every 8 hours
Note:
- Tinidazole 500 mg every 12 hours can be used instead of metronidazole
- Confirm eradication with stool antigen test a month after completion of treatment; test should be negative