Peptic Ulcer

The treatment of duodenal, or peptic ulcers was altered radically when it was discovered that H. pylori infection was one of the main causes. Relationship Between Helicobacter pylori Eradication and Reduced Duodenal and Gastric Ulcer Recurrence: A Review. Gastroenterology. 1996.  Prospective double-blind trial of duodenal ulcer relapse after eradication of campylobacter pylori. The Lancet. 1988.

Duodenal ulcers recurred in fewer than 10% of patients who were treated for H. pylori compared to 60-65% of those who were not in the Gastroenterology paper above.

History

Three typical dyspeptic patterns: Functional Gastroduodenal Disorders. Gastroenterology. 2006.

Need to be aware that differential diagnosis could include:

  • Gastro-oesophageal reflux disease (GORD).
  • NSAID dyspepsia.
  • Underlying malignancy.
  • Acute cholecystitis.

These patterns overlap and have poor predictive value for findings at endoscopy. Accuracy of provisional diagnoses of dyspepsia in patients undergoing first endoscopy. Gastrointestinal Endoscopy. 2001.  GPs’ ability to diagnose dyspepsia based only on physical examination and patient history. Scand J Prim Health Care. 2000Can the Clinical History Distinguish
Between Organic and Functional Dyspepsia? JAMA. 2006.

Perforation

Three phases have been identified:

  • Within 2 hours of onset abdo pain is usually sudden. Localisation is epigastric but then becoming generalised. Signs of shock become apparent. Pain may radiate to the right shoulder or to bot shoulders.
  • 2 to 12 hours after onset the pain may improve. Pain is worse upon movement and the abdomen displays board like rigidity.
  • In the third phase abdominal distension may become apparent. Temperature and hypovoleamia develop and cardiovascular collapse may occur as peritonitis advances.

Management of Peptic Ulcer

Dyspepsia and gastro-oesophageal reflux disease. NICE

Rome III Diagnostic Criteria for Functional Gastrointestinal Disorders. Am Journal of Gastroenterology.

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