Peptic Ulcer Disease

Introduction:

2 types viz gastric and duodenal.

Gastric ulcers are now common than duodenal ulcers and in the small intestine, they are associated with Meckel's diverticulum.

Causes:

The major causes are H. pylori (duodenal + gastric) or NSAIDs (gastric), Zollinger-Ellison syndrome, CMV and HSV infection.

Pathogenesis:

H. pylori infection may be prerequisite for almost all duodenal ulcers in absence of NSAIDs or ZE and 80% non-NSAID-induced gastric ulcers, yet most H. pylori-infected individuals do not develop ulcersacid is necessary, reduced bicarbonate, increased acid.

Complications:

• bleeding
• perforation, especially duodenal
• diabetes associated with increased 30-day mortality in patients with bleeding or perforated peptic ulcer
• older age associated with increased 30-day mortality in patients with bleeding or perforated peptic ulcer
• 5% gastric outlet obstruction
• posterior penetration (severe back pain), pancreatitis

Treatment:

• clarithromycin 500 mg twice daily
• amoxicillin 1 g twice daily
• metronidazole 500 mg twice daily