Definition
A peptic ulcer is a break in the epithelial surface of the stomach or duodenum (or Meckel’s diverticulum) caused by the action of gastric secretions (acid and pepsin) and infection with Helicobacter pylori.
Key Points
- Not all dyspepsia is due to peptic ulcer disease (PUD).
- The majority of chronic duodenal ulcers are related to H. pylori infection and respond to eradication and antisecretory therapy.
- Patients ≥45 years or with suspicious symptoms require endoscopy to exclude malignancy.
- Surgery is limited to complications of ulcer disease.
Common Causes
- Infection with H. pylori (gram-negative spirochete).
- NSAIDs.
- Imbalance between acid/pepsin secretion and mucosal defence.
- Alcohol, cigarettes and ‘stress’.
- Hypersecretory states e.g. gastrin hypersecretion in the ZE-syndrome or antral G cell hyperplasia).
Clinical Features
Duodenal Ulcer and Type II Gastric Ulcer (i.e. Prepyloric and Antral)
- Male : female 1:1, peak incidence 25–50 years.
- Epigastric pain during fasting (hunger pain), relieved by food/antacids, often nocturnal, typically exhibits periodicity (i.e. recurs at regular intervals).
- Boring back pain if ulcer is penetrating posteriorly.
- Haematemesis from ulcer penetrating gastroduodenal artery posteriorly.
- Peritonitis if perforation occurs with anterior DU.
- Vomiting if gastric outlet obstruction (pyloric stenosis) occurs (note succussion splash and watch for hypokalaemic, hypochloraemic alkalosis).
Type I Gastric Ulcer (i.e. Body of Stomach)
- Male : female 3:1, peak incidence 50+ years.
- Epigastric pain induced by eating.
- Weight loss.
- Nausea and vomiting.
- Anaemia from chronic blood loss.
Investigations
- FBC: to check for anaemia.
- U+E.
- Faecal occult blood.
- OGD:
necessary to exclude malignant gastric ulcer in:
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