Definition

Ulcer within the stomach or duodenum.

Epidemiology

Pathophysiology

The most common cause for this is Helicobacter pylori but there are lots of other risks.

Risk Factors

• NSAIDs
• Pepsin
• Smoking
• Alcohol
• Bile acids
• Traditionally, steroids though we think this is debatable[[1]]

Clinical Features

• Most common symptom: epigastric pain, particularly after eating (postprandial). This may radiate to the back if there is a posterior ulcer
• Nausea & oral flatulence
• Symptoms relieved by antacids

Investigations

• H.pylori testing

Bloods

• FBC - iron deficiency anaemia

Imaging

Endoscopy is required in all ages if:

• Iron deficiency anaemia
• Chronic blood loss
• Progressive dysphagia
• Weight loss
• Persistent vomiting
• Epigastric mass

And required in >55yrs if: previous ulcer; previous gastric surgery; pernicious anaemia; NSAID use; family history.

Management

Behaviour modification: encourage patient to stop smoking and reduce alcohol intake.

H.pylori positive: eradication therapy is indicated.

H.pylori negative, NSAID-induced:

• Stop NSAID
• PPI for 2 monhts

H.pylori & NSAID negative:

• May require further investigation

Indication for repeat endoscopy

• Failure to eradicate symptoms in a duodenal ulcer
• Failure to eradicate H.pylori
• Gastric ulcer

Prognosis