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PEPTIC ULCERATION

Introduction

Peptic ulceration is a term which includes both gastric and duodenal ulceration.

A peptic ulcer consists of a break in the supercial epithelial cells penetrating downto the muscularis mucosa of either the stomach or the duodenum. It is associated

with a brous base and an increase in inammatory cells.

Gastric ulcer Duodenal ulcerPopulation Middleaged!elderly male "oungmiddleaged male#isk factors $.pylori %&'(')*

+,AID use %increase risk

by - times*

Delayed gastric emptying

$.pylori %/(')*

+,AID use

Gastric hyperacidity

#apid gastric emptyingPresentation Dyspepsia

0pigastric pain worsenedby food and helped by

antacids or lying at 1

weight loss

2Anore3ia and weight loss

Dyspepsia

0pigastric pain typicallyrelie4ed by food and

worse at night 1

o4erweight

03amination %It is usually

normal in the

uncomplicated cases*

May be epigastric!left

upper 5uadrant

tenderness

May be epigastric

tenderness

In4estigation ,ame as dyspepsia %0ndoscopy ! $.pylori test*2Complications $aemorrhage

Perforated peptic ulcer

Pyloric stenosis in adults %duodenal stenosis secondary

to scarring from a chronic D6*

Helicobacter pylori infection

$.pylori is a slowgrowing spiral Gram-negative fagellateureaseproducing

bacterium. It coloni7es the mucous layer in the gastric antrum8 but is also found in

the duodenum in areas of gastric metaplasia. It adheres specically to gastric

epithelial cells and being protected from gastric acid by the 9u3tamucosal mucous

layer which traps bicarbonate secreted by antral cells8 and ammonia produced by

bacterial urease.

Antral cells Bicarbonate ions

$. pylori 6rease %6rea NH: ;

Adapted to the

en4ironment which is

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Antral gastritis

Peptic ulcers

Gastric cancer

In!esti"ation

0ndoscopy for those who meet the referral criteria as below> #$Alarm

symptoms% ;hronic gastrointestinal bleeding Progressi4e unintentional weight loss Progressi4e di?culty swallowing Persistent 4omiting IDA 0pigastric mass ,uspicious barium meal A"e & ''yand recentonset and persistent8 une3plained dyspepsia Pre4ious gastric ulcer or surgery

;ontinuing need for +,AID treatment Increase risk of gastric cancer An3iety about cancer

@,

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Resistant infections Hismuth chelate ='mg tds

Metronida7ole ''mg tds

etracycline J''mg 5ds

PPI =''mg HD

2;heck eradication with repeat endoscopy %gastric ulcer* or urea breath test

%duodenal ulcer*

If negati4e $.pylori

Eull dose PPI %eg.