Peptic Ulcer Disease & GORD

Peptic Ulcer Disease & GORD

Peptic Ulcer Disease (PUD)

Aetiology:

• *H. pylori* infection (~70% of duodenal, ~50% gastric ulcers)
• NSAIDs: inhibit COX-1 → Ôåô prostaglandins → Ôåô mucus/bicarbonate, Ôåô mucosal blood flow
• Other: Zollinger-Ellison syndrome (gastrinoma → massive acid hypersecretion)

Duodenal vs Gastric Ulcer:

| Feature | Duodenal | Gastric |

|---------|----------|--------|

| Pain timing | Relieved by food | Worse with food |

| H. pylori | 90-95% | 70% |

| Malignant risk | Very low | Must biopsy |

H. pylori Diagnosis & Treatment

• Diagnosis: urea breath test (active infection), stool antigen test, serology (past exposure), CLO test (endoscopy biopsy)
• Eradication: triple therapy — PPI + clarithromycin + amoxicillin ├ù 7 days
• Confirm eradication: urea breath test ÔëÑ4 weeks post-treatment

Upper GI Bleed

• Rockford (Rockall) score: pre-endoscopy (age, shock, comorbidities), post-endoscopy (stigmata, diagnosis)
• Initial: two large-bore IV, FBC/U&E/LFT/clotting/G&S, IV PPI, endoscopy <24 h (urgent if haemodynamically unstable)
• Endoscopic haemostasis: adrenaline injection + thermal/clip for high-risk stigmata

GORD

• Mechanism: lower oesophageal sphincter incompetence → acid reflux
• Complications: oesophagitis, Barrett's oesophagus (columnar metaplasia), stricture, adenocarcinoma
• Management: lifestyle (weight loss, head of bed elevation, avoid triggers), PPI
• Barrett's: surveillance endoscopy, radiofrequency ablation if dysplasia