Peptic ulcer disease is caused by Helicobacter pylori infection in about 60% of stomach ulcers and 90% of duodenal ulcers. Symptoms include epigastric or retrosternal pain associated with meals. Treatment involves stopping NSAIDs, taking a PPI or H2RB to heal 90% of ulcers, and treating any H. pylori infection with a PPI and antibiotics. Complications include bleeding, perforation, penetration into adjacent organs, and gastric outlet obstruction.

1. Peptic ulcer disease
Mucosal erosion >0.5 cm
in distal esophagus,
stomach, proximal duodenum

2. Cause
 Helicobacter pylori infection
 Gram –ve bacilli, in antral mucosa
 Responsible for ~60% stomach ulcers &
~90% doudenal ulcers
 NSAIDs
 Gastrinoma- Zollinger-Ellison syndrome
 ?Stress- burns/head injury/sepsis

3. Symptoms
Pain- epigastric/retrosternal
Association with meals- common
gastric exacerbated, duodenal
relieved

4. Complications
 UGI bleeding- hematemesis/malena
 Perforation- peritonitis/pancreatitis
 Penetration into adjacent organs
 Gastric outlet obstruction
 Cancer- stomach- consider if,
symptoms in person >45 years of age
or weight loss
or greater curvature ulcer

5. Diagnosis
 UGIE/EGD- to visualise ± biopsy ulcer
 Dx of H. pylori infection-
 Urea breath test
 Stool antigen test
 Blood antibody test- poor sensitivity & specificity
 Urease activity in biopsy specimen
 Histological examination of biopsy specimen
 Staining & culture of biopsy specimen

6. Treatment
 Stop NSAIDs, if necessary add PPI or Misoprostol
 PPI x 4 weeks or H2RB x 6-8 weeks
heal ~90% of peptic ulcers
 H. pylori Rx-
 1 PPI + 2 antibiotics x 7-14 days
Clarithromycin, Amoxycillin, Metronidazole
 If large ulcer, continue PPI x 4 more weeks
 Recurrence ~10% in 1 year (~85%, if H. pylori untreated)
 No H. pylori- long-term, higher dose PPI
 Complications-
 Bleeding- cautery/injection/clipping by UGIE
 Others- surgery

7. Treatment
 Stop NSAIDs, if necessary add PPI or Misoprostol
 PPI x 4 weeks or H2RB x 6-8 weeks
heal ~90% of peptic ulcers
 H. pylori Rx-
 1 PPI + 2 antibiotics x 7-14 days
Clarithromycin, Amoxycillin, Metronidazole
 If large ulcer, continue PPI x 4 more weeks
 Recurrence ~10% in 1 year (~85%, if H. pylori untreated)
 No H. pylori- long-term, higher dose PPI
 Complications-
 Bleeding- cautery/injection/clipping by UGIE
 Others- surgery