Peptic Ulcer Disease

Peptic Ulcer Disease
  • Evaluation
    • General—lesion of the mucous membrane lining the stomach or duodenum
    • Clinical—epigastric pain (aching, gnawing) that can be intermittent, dyspepsia, with or without nausea/vomiting
      • Gastric ulcer—pain occurs minutes after eating and can last for hours (until stomach is empty).
      • Duodenal ulcer—pain relieved by eating, but may return up to 4 hours later.
    • Etiology—many factors are associated with peptic ulcer disease (PUD), although these are the most common
      • Helicobacter pylori infection—acts by inducing mucosal inflammation and cytokine release.
      • Nonsteroidal anti-inflammatory drug (NSAID)/aspirin use— acts by inhibiting prostaglandin synthesis, which protects mucosa.
        • Those who use these agents are also at increased risk of complicated ulcers, bleeding, and so on.
    • Epidemiology—8% to 14% lifetime prevalence with complicating ulcer disease occurring with increased age
    • Risk factors—(independent of Haemophilus pylori (H. pylori) or NSAIDs)
      • Advanced age (age older than70 years)
      • History of PUD or complicated ulcer disease
      • Concomitant warfarin or corticosteroid administration
      • Smokers—These individuals having impaired ulcer healing
      • Alcohol—unclear effect on patients without coexisting liver disease
    • Diagnostic algorithm—typically encompasses the differential of dyspepsia (see Chapter 2.24)
      • Alarm symptoms (gastrointestinal [GI] bleeding, weight loss, obstruction, etc.) require evaluation with esophagogastroduodenoscopy (EGD).
      • In the absence of alarm symptoms
        • H. pylori infection
          • “Test and Treat”—H. pylori antibody test (enzymelinked immunosorbent assay [ELISA]) and treatment if positive
            • If symptoms persist, then evaluate with EGD.
        • NSAID/aspirin user
          • Discontinue NSAID/aspirin; consider proton pump inhibitor (PPI) trial.
            • If symptoms persist, then evaluate with EGD.
  • Treatment
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Aug 28, 2016 | Posted by in PSYCHIATRY | Comments Off on Peptic Ulcer Disease

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