General Medicine
Peptic Ulcer and Dyspepsia
Peptic ulcer and dyspepsia for MBBS: Helicobacter pylori and NSAID causes, alarm features, testing and endoscopy, eradication therapy and complications.
MedNext Academy | 3 min read
Peptic Ulcer and Dyspepsia
Peptic ulcer and dyspepsia for MBBS: Helicobacter pylori and NSAID causes, alarm features, testing and endoscopy, eradication therapy and complications.
This supplementary chapter covers dyspepsia and peptic ulcer disease, focusing on the two main causes of Helicobacter pylori and non-steroidal anti-inflammatory drugs. It emphasises the recognition of alarm features, the role of testing and endoscopy, eradication therapy and the management of ulcer complications.
High-yield: Peptic Ulcer and Dyspepsia
- Dyspepsia is upper abdominal pain or discomfort that may be functional or due to organic disease.
- The two main causes of peptic ulcer disease are Helicobacter pylori infection and non-steroidal anti-inflammatory drug use.
- Duodenal ulcer pain classically improves with food, while gastric ulcer pain is often worsened by eating.
- Alarm features such as weight loss, dysphagia, bleeding, anaemia and a mass warrant prompt endoscopy.
- New-onset dyspepsia in an older patient is an alarm feature that requires endoscopy to exclude malignancy.
- Helicobacter pylori can be tested for non-invasively by the urea breath test or stool antigen test.
- Endoscopy allows direct visualisation, biopsy and testing for Helicobacter pylori during upper gastrointestinal evaluation.
- Helicobacter pylori eradication uses a proton pump inhibitor with two antibiotics for a defined course.
- Proton pump inhibitors are the most effective acid-suppressing drugs for peptic ulcer healing.
- Non-steroidal anti-inflammatory drug ulcers are managed by stopping the drug where possible and giving a proton pump inhibitor.
- A perforated peptic ulcer causes sudden severe pain with peritonitis and free air under the diaphragm.
- Bleeding peptic ulcer is a common cause of upper gastrointestinal haemorrhage and needs endoscopic therapy.
- Gastric ulcers should be followed up to confirm healing and exclude an underlying malignancy.
- Confirmation of Helicobacter pylori eradication is advised after treatment in appropriate cases.
- Lifestyle measures and avoiding ulcerogenic drugs reduce the risk of recurrence.
Peptic ulcer and dyspepsia essentials
- **Main causes:** Helicobacter pylori infection and non-steroidal anti-inflammatory drug use.
- **Alarm features:** Weight loss, dysphagia, bleeding, anaemia, a mass or new dyspepsia in the older patient prompt endoscopy.
- **Testing:** Non-invasive urea breath or stool antigen test; endoscopy with biopsy when indicated.
- **Treatment:** Proton pump inhibitor for healing; triple therapy to eradicate Helicobacter pylori.
Frequently Asked Questions
What are the two main causes of peptic ulcer disease?
The two main causes are Helicobacter pylori infection and the use of non-steroidal anti-inflammatory drugs, and identifying and treating these is central to management.
When does dyspepsia require endoscopy?
Endoscopy is required when alarm features are present, such as weight loss, dysphagia, gastrointestinal bleeding, anaemia, a palpable mass, or new-onset dyspepsia in an older patient.
How is Helicobacter pylori treated?
Eradication uses a proton pump inhibitor combined with two antibiotics for a defined course, with confirmation of eradication advised afterwards in appropriate cases.
How does this chapter help for NEET-PG?
The causes of peptic ulcer, alarm features prompting endoscopy, Helicobacter pylori testing and eradication are common exam themes in general medicine and gastroenterology.
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