Peptic Ulcer Disease (Gastric vs. Duodenal Ulcers) | Causes, Symptoms, Diagnosis, Treatment

JJ Medicine
9 Apr 202115:20

Summary

TLDRThis lesson covers peptic ulcer disease, explaining its causes, symptoms, diagnosis, and treatment. Peptic ulcers occur when destructive processes in the gastrointestinal mucosa exceed protective mechanisms. Key causes include Helicobacter pylori infection and NSAID use. Symptoms include epigastric pain, nausea, and possible bleeding. Diagnosis involves procedures like EGD and stool antigen tests. Treatment focuses on removing the cause, using proton pump inhibitors, and sometimes antibiotics for H. pylori. Avoiding factors like NSAIDs, smoking, and alcohol is crucial. The lesson also discusses complications, including bleeding, perforation, and obstruction.

Takeaways

  • 😀 Peptic ulcer disease (PUD) refers to ulcers in the gastrointestinal mucosa, particularly in the stomach and duodenum, caused by an imbalance between destructive and protective factors.
  • 😀 The most common cause of PUD is Helicobacter pylori infection, followed by the use of NSAIDs (e.g., ibuprofen), corticosteroids, and certain other medications.
  • 😀 Duodenal ulcers are four times more common than gastric ulcers and are more frequently seen in males.
  • 😀 Key risk factors that may worsen peptic ulcer disease include alcohol, smoking, and chronic stress, which can impair healing and increase ulcer complications.
  • 😀 Gastric ulcers typically cause pain 15-30 minutes after eating, often worsened by food, while duodenal ulcers tend to cause pain 1-3 hours after meals, sometimes relieved by eating.
  • 😀 20% of patients with peptic ulcer disease are asymptomatic, while the most common symptom is dyspepsia, described as a burning or gnawing pain in the upper abdomen.
  • 😀 Severe complications of PUD include bleeding (hematemesis, melena), perforation, gastric outlet obstruction, and pancreatitis (especially with posterior ulcers).
  • 😀 Diagnosis of PUD is mainly through esophagogastroduodenoscopy (EGD), which allows for direct visualization and biopsy of ulcers. H. pylori infection can be confirmed via serology, stool antigen test, or biopsy.
  • 😀 The treatment of PUD is centered on eliminating the underlying cause (e.g., H. pylori), using proton pump inhibitors (PPIs) to promote healing, and avoiding NSAIDs, smoking, and alcohol.
  • 😀 For H. pylori-related ulcers, triple therapy (amoxicillin, clarithromycin, and PPI) is used for 7-14 days to eradicate the infection and facilitate healing.
  • 😀 Certain special cases of PUD include Curling's ulcers (from severe burns) and Cushing's ulcers (from increased intracranial pressure).

Q & A

  • What is peptic ulcer disease?

    -Peptic ulcer disease (PUD) refers to the development of ulcers or focal defects in the gastrointestinal mucosa, affecting the esophagus, stomach, or duodenum. It most commonly affects the stomach (gastric ulcer) or duodenum (duodenal ulcer).

  • What are the main causes of peptic ulcer disease?

    -The primary causes of peptic ulcer disease include Helicobacter pylori infection and the use of nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen. Other causes include viral infections (e.g., cytomegalovirus), stress, Crohn's disease, and conditions like Zollinger-Ellison syndrome and gastrinomas.

  • What role do NSAIDs play in the development of peptic ulcers?

    -NSAIDs inhibit cyclooxygenase 1 (COX-1), which reduces prostaglandin synthesis. Prostaglandins normally protect the gastrointestinal mucosa, so NSAID use for extended periods diminishes this protective effect, leading to ulcer formation.

  • How does Helicobacter pylori cause peptic ulcers?

    -Helicobacter pylori infection leads to inflammation of the stomach lining, causing an imbalance between destructive processes and protective mechanisms in the mucosa. The bacteria burrow into the stomach lining, promoting prolonged inflammation that can eventually result in ulceration.

  • What are the differences in symptoms between gastric and duodenal ulcers?

    -Gastric ulcers typically cause pain or discomfort soon after eating (15–30 minutes), and symptoms can be worsened by food. Duodenal ulcers, on the other hand, cause pain 1–3 hours after meals and can be relieved by eating or taking antacids. Duodenal ulcers also tend to have a waxing and waning pattern of symptoms.

  • What are the most common symptoms of peptic ulcer disease?

    -The most common symptom is dyspepsia, which presents as epigastric discomfort or pain (burning, gnawing, bloating). Other symptoms include early satiety (feeling full quickly), nausea, vomiting, and weight changes. More severe symptoms may include gastrointestinal bleeding, which can cause hematemesis or melena.

  • What complications can arise from peptic ulcer disease?

    -Complications of PUD include gastrointestinal bleeding, ulcer perforation, gastric outlet obstruction, and pancreatitis (especially with posterior ulcers). These complications can be life-threatening and require immediate medical intervention.

  • How is peptic ulcer disease diagnosed?

    -The gold standard for diagnosing peptic ulcer disease is esophagogastroduodenoscopy (EGD), where a scope is used to visually inspect the gastrointestinal tract for ulcers. Additional tests can include biopsy for H. pylori, stool antigen testing, and serological tests to detect past infections.

  • What is triple therapy for H. pylori infection in peptic ulcer disease?

    -Triple therapy involves using a combination of antibiotics (clarithromycin and amoxicillin, or metronidazole if allergic to amoxicillin) along with a proton pump inhibitor (PPI) to eradicate H. pylori infection. This therapy is typically administered for 7–14 days.

  • What lifestyle factors should be avoided to prevent worsening of peptic ulcers?

    -To prevent worsening of peptic ulcers, patients should avoid smoking, excessive alcohol consumption, and NSAID use. Smoking and alcohol can hinder the healing process, while NSAIDs can exacerbate the damage to the gastrointestinal mucosa.

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Related Tags
Peptic UlcerGastrointestinal HealthUlcer TreatmentH. PyloriNSAIDsStomach UlcersDuodenal UlcersGastric HealthClinical DiagnosisMedical EducationHealth Lessons