Peptic Ulcer Disease (PUD)

Gastroenterology (12%) Core Clinical Conditions

1A: Able to diagnose and manage

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Definition Aetiology Pathophysiology Risk factor Sign and Symptoms Investigations Management

Peptic Ulcer Disease (PUD) refers to the formation of open sores or ulcers in the lining of the stomach (gastric ulcers) or the upper part of the small intestine (duodenal ulcers). These ulcers are characterised by erosions or breaks in the protective mucosal lining, exposing the underlying tissue to stomach acid and digestive enzymes. PUD can lead to a range of symptoms and complications.

The main aetiology of peptic ulcer disease (PUD) is the disruption in the equilibrium between substances that promote gastric and duodenal damage and those that provide protection. Aggressive factors include the existence of Helicobacter pylori bacteria, increased stomach acid secretion, and the utilisation of non-steroidal anti-inflammatory medicines (NSAIDs). Protective factors include the physiological mechanisms of mucus production and the inherent ability of the human body to undergo repair and regeneration of the mucosal lining. Ulcers may form when the prevalence of aggressive causes surpasses that of defensive systems.

• Helicobacter pylori Infection: This bacterium weakens the mucosal barrier and triggers inflammation, making the mucosa more susceptible to damage from gastric acid.

• Excessive Gastric Acid: Overproduction of stomach acid can directly damage the mucosal lining, leading to ulcer formation.

• NSAID Use: Non-steroidal anti-inflammatory drugs, such as aspirin and ibuprofen, can irritate the stomach lining and reduce protective mucus production, increasing the risk of ulcers.

• Helicobacter pylori Infection: This bacterial infection is a significant risk factor for PUD.

• Regular NSAID Use: Frequent use of NSAIDs, especially in high doses, can increase the risk.

• Smoking: Smoking impairs the healing of ulcers and increases the likelihood of recurrence.

• Excessive Alcohol Consumption: Heavy alcohol use can irritate the stomach lining and increase the risk of ulcers.

• Stress: While stress alone is not a direct cause, it can exacerbate PUD symptoms.

• Heartburn: A burning sensation or discomfort in the chest, often after eating or lying down.

• Regurgitation: The sensation of stomach contents or acid rising into the throat or mouth.

• Dysphagia: Difficulty swallowing or the feeling of food getting stuck in the throat.

• Chronic Cough: A persistent cough, often worse at night.

• Hoarseness: Changes in the voice or recurrent sore throat.

• Upper Endoscopy: This procedure allows direct visualization of the stomach and duodenum to identify ulcers and obtain biopsies for H. pylori testing.

• H. pylori Testing: This can include blood tests, breath tests, or stool tests to detect the presence of H. pylori bacteria.

• Imaging: X-rays or CT scans may be used in some cases.

• Antibiotics: If H. pylori infection is present, a course of antibiotics is prescribed to eradicate the bacteria. Use the acronym PPI, Amoxicillin and clarithromycin (PAC) twice a day for 7 days.

• Proton Pump Inhibitors (PPIs): These medications reduce gastric acid production, allowing ulcers to heal.

• Histamine H2 Receptor Blockers: such as Famotidine, these drugs also reduce acid production.

• Antacids: They provide relief from acid-related symptoms.

• Lifestyle Modifications: Patients are advised to avoid smoking, limit alcohol and caffeine intake, and manage stress.

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