Peptic ulcer
Ulcer sites: oesophagus, stomach, duodenum, and meckel's diverticulum.
Possible exacerbating factors: stress, smoking, alcohol, NSAIDS, steroids and Helicobacter pylori.
Clinical features: DU: epigastric pain, radiation to the back, eating relieves the pain (so weight gain), worse at night, waterbrash. With gastric ulcers the pain may be worse by day. Chief dangers are GI bleeding and perforation.
Investigations: endoscopy, biopsy, barium studies and consider rebiopsying all gastric ulcers after 4 weeks of treatment to exclude malignancy.
Treatment: remove exacerbating factors, use antacids, and give histamine antagonist for 8 weeks eg cimetidine or ranitidine. 90% of all ulcers heal, but relapse on stopping the drug is very common. 60-95% of those relapsing on stopping H2 antagonists has infection with Helicobacter pylori. This is best treated with triple regime, bismuth chelate + amoxycillin + metronidazole. Consider surgery.
Other drugs: omeprazole may heal resistant ulcers and work by blocking the proton pump of gastric parietal cells. Sucralfate may protect mucosa from acid pepsin attack.
SE: cimetidine: gynaecomastia ± impotence.
Bismuth: stool blackening; CI: renal disease and pregnancy
Sucralfate: pruritus, vertigo, back pain, dry mouth and insomnia.