D4

Peptic Ulcer Disease (PUD) definition and location?

Painful sores or ulcers develop in the stomach lining or first part of the duodenum.

Peptic Ulcer Disease (PUD) population prevalence?

Present in 4% of the population.

Peptic Ulcer Disease (PUD) risk factors?

H.pylori (MC), NSAIDs, smoking, personal or family history.

PUD clinical history typical discomfort presentation?

Dyspepsia, heartburn, chest discomfort.

PUD clinical history recurrent pain characteristics?

Recurrent upper abdominal pain: in epigastrium, episodic occurrence, related to food.

PUD clinical history post-meal symptoms?

Vomiting or early satiety after meals.

PUD clinical history bleeding signs?

Hematemesis or melena due to GI bleeding.

PUD Alarm features (Bleeding & Anemia)?

Bleeding or anemia.

PUD Alarm features (Satiety & Weight)?

Early satiety, unexplained weight loss.

PUD Alarm features (Swallowing & Gastric output)?

Progressive dysphagia or odynophagia. Recurrent vomiting.

H. pylori indications for testing (Non-endoscopy)?

Patients who do not require upper endoscopy.

H. pylori indications for testing (Endoscopy without biopsy)?

Patients in whom biopsies were not performed during upper endoscopy.

H. pylori non-invasive diagnostic tests?

Urea breath test (most accurate non-invasive). Serology testing for antibodies. Fecal antigen test.

H. pylori invasive diagnostic tests?

Rapid urease test / CLO test. Histology. Culture of organism.

H. pylori triple therapy (1st line, 1 week) regimen?

PPI twice daily. Amoxicillin 500-1 g twice daily or Metronidazole 400-500 mg twice daily. Clarithromycin 500 mg twice daily.

H. pylori quadruple therapy (2nd line, 2 weeks) regimen?

PPI twice daily. Bismuth subcitrate 120 mg QDS. Metronidazole 400–500 mg TDS. Tetracycline 500 mg QDS.

PUD diagnosis methods?

Methods: H.pylori testing, UGE.

PUD prevalence among referred cases?

Only 20-25% of referred cases have really PUD.