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.
Three typical dyspeptic patterns: Functional Gastroduodenal Disorders. Gastroenterology. 2006.
- Ulcer like or acid dyspepsia.
- burning pain. Systematic Review of the Symptom Burden, Quality of Life Impairment and Costs Associated with Peptic Ulcer Disease. Am J of Medicine. 2010.
- Epigastric hunger like pain. It may radiate to the right or left upper quadrants or hypochondrium. A computerized questionnaire analysis of duodenal ulcer symptoms. Gastroenterology. 1976.
- Classic duodenal symptoms occur 2-5 hours after meals.
- Symptoms will often also occur at night.
- relief with food, antacids and/or antisecretory agents.
- Food provoked dyspepsia
- Post prandial epigastric discomfort and fulness
- early satiety
- nausea and occasional vomiting. Association between clinical manifestations of complicated and uncomplicated peptic ulcer and visceral sensory dysfunction. J of Gastroenterology and Hepatology. 2010. Systematic Review of the Symptom Burden, Quality of Life Impairment and Costs Associated with Peptic Ulcer Disease. Am J of Medicine. 2010.
- Reflux like dyspepsia.
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. 2000. Can the Clinical History Distinguish
Between Organic and Functional Dyspepsia? JAMA. 2006.
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
- Proton pump inhibitor therapy. American College of Gastroenterology Guideline on the Management of Helicobacter pylori Infection. Am J of Gastroenterology. 2007.
- Testing and management of Helicobacter pylori.