Test 3: Peptic Ulcer Disease (PUD: Gastric & Duodenal)

What is a peptic ulcer?

A break or erosion in the mucosal lining of the stomach or duodenum caused by gastric acid and pepsin imbalance, leading to tissue damage.

Where are peptic ulcers most commonly found?

• Duodenum (most common)

• Stomach (gastric ulcers)

• Less commonly: lower esophagus or jejunum

What are the leading causative factors for PUD?

• Helicobacter pylori infection (most common)

• NSAID or aspirin use (disrupts mucosal protection)

• Excess gastric acid (Zollinger-Ellison syndrome)

• Smoking and alcohol (impair healing)

• Stress or critical illness (stress ulcers, less common)

How does gastric ulcer pathophysiology differ from duodenal ulcer?

• Gastric ulcer: impaired mucosal defense → acid damages stomach lining

• Duodenal ulcer: excessive acid production overwhelms duodenal mucosa

How do symptoms differ for gastric vs. duodenal ulcers?

Feature	Gastric Ulcer	Duodenal Ulcer
Pain location	Epigastric, left upper abdomen	Epigastric, right upper abdomen
Pain timing	30–60 min after meals	1.5–3 hrs after meals; often at night
Effect of food	Food may increase pain	Food may relieve pain
Other symptoms	Nausea, vomiting, weight loss	Nausea, vomiting, weight usually stable

What are the three major complications of peptic ulcer disease?

• Hemorrhage: GI bleeding → melena, hematemesis

• Perforation: ulcer erodes through stomach/duodenal wall → peritonitis

• Obstruction: swelling or scarring → gastric outlet obstruction, vomiting, abdominal distension

How are peptic ulcers treated?

Acute exacerbation/conservative therapy includes:

• Medications:

  • Proton pump inhibitors (PPIs): omeprazole, pantoprazole → reduce acid and allow healing

  • H2 receptor antagonists: ranitidine, famotidine → reduce acid secretion

  • Antacids: neutralize acid for symptom relief

  • Cytoprotective agents: sucralfate, misoprostol → protect mucosa

  • Antibiotics: for H. pylori (clarithromycin + amoxicillin or metronidazole)

• Lifestyle modifications: avoid NSAIDs, alcohol, caffeine, spicy foods, smoking

What patient teaching is important for PUD?

• Take medications exactly as prescribed, complete antibiotic course for H. pylori

• Avoid NSAIDs or use alternatives (acetaminophen)

• Eat small, frequent meals; avoid irritants

• Manage stress (relaxation techniques)

• Report signs of bleeding (hematemesis, melena), severe pain, or vomiting

When is surgical intervention indicated for PUD?

• Refractory ulcers not healing with medical therapy

• Complications: perforation, uncontrolled bleeding, obstruction

• Procedures may include partial gastrectomy, vagotomy, or pyloroplasty

How should monitoring and follow-up occur?

• Endoscopy to confirm healing for complicated or gastric ulcers (especially in patients >50 or with alarm symptoms)

• Monitor for recurrence, medication side effects, and lifestyle adherence