Peptic ulcer disease

• Peptic ulcer disease is the errosion of the GI mucosa that results from the digestive action of hydrochloric acid and pepsin. Can be acute or chronic
• Any portion of the GI tract that comes in contact with gastric secretion is susceptible for ulcer development = esophagus, stomach, duodenum
• Causes and risk factors

  • H pylori
  • medication (NSAID, ASA, corticosteroid)
  • alcohol
  • ischemia
  • smoking
  • diet
• H Pylori

  • bacillus that colonizes the stomach & duodenum
  • most common cause of PUD especially duodenal ulcers
  • may promote gastric cancer
  • eradication of it promotes healing of PUD and minimizes the recurrence
• H Pylori tests:

  • gastroscopy: culture
  • urea breath test: by product of metabolism of H Pylori bacteria
  • serologic test
  • stool test
• Clinical manifestations

  • possibly asymptomatic
  • dyspepsia
  • pain relieved by antacids or H2R blockers or PPIs
• Complications

  • hemorrhage
  • perforation (if stomach content goes into the abdomen, it can cause septic shock)
  • gastric outlet obstruction: gastric caused by stasis and gastric dilation
• Subjective assessment

  • current and past health history
  • use of medications
  • weight loss
  • anorexia
  • nausea and vomiting
• Objective assessment

  • appearance of stool (black and tarry)
  • epigastric tenderness or back pain
  • hematemesis (vomit blood)
  • low Hb and Hct lab values
  • guaiac positive stools
  • positive H pylori test
• Diagnostic studies

  • gastroscopy with biopsy
  • H pylori test
  • barium studies
  • CBC and gaiac test (bleeding)
• Management

  • smoking cessation
  • meds: H2 blockers, PPIs, antacids, antibiotics
  • nutritional therapy: avoid irritating foods and promote pH neutralizing foods like protein
• PUP develops when there in an unbalance between mucosal defenses (mucus, bicarbonate, blood flow, prostaglandins) and aggressive factors (H Pylori, NSAIDs, acid, pepsin and smoking)