Peptic Ulcer Disease and H. pylori Infection: PLAB 1 Core Knowledge
This module covers Peptic Ulcer Disease (PUD) and its primary cause, Helicobacter pylori (H. pylori) infection, crucial for your PLAB 1 preparation. Understanding the pathophysiology, diagnosis, and management of these conditions is vital for assessing and treating patients effectively.
What is Peptic Ulcer Disease (PUD)?
Peptic Ulcer Disease refers to open sores that develop on the inside of the stomach and the upper part of the small intestine (duodenum). The most common sites are the stomach lining and the duodenum. These ulcers occur when the protective mucous layer of the digestive tract is eroded, allowing digestive acids to damage the underlying tissues.
The Role of *Helicobacter pylori* (H. pylori)
Helicobacter pylori is a gram-negative bacterium that is the most common cause of peptic ulcers worldwide. It colonizes the gastric mucosa, leading to chronic inflammation and increasing the risk of ulcer formation. It's estimated that a significant percentage of individuals with peptic ulcers are infected with H. pylori.
Other Causes and Risk Factors for PUD
| Factor | Mechanism of Action | Impact on PUD |
|---|---|---|
| NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) | Inhibit cyclooxygenase (COX) enzymes, reducing prostaglandin synthesis. Prostaglandins are crucial for maintaining mucosal integrity and blood flow. | Directly damage the gastric mucosa and impair its ability to repair, increasing ulcer risk. |
| Zollinger-Ellison Syndrome | A rare condition characterized by gastrin-producing tumors (gastrinomas) that lead to excessive gastric acid secretion. | Causes severe, often multiple, and recurrent peptic ulcers due to overwhelming acid production. |
| Smoking | Reduces mucosal blood flow, impairs healing, and may increase acid secretion. | Slows ulcer healing and increases the risk of recurrence. |
| Alcohol | Can directly irritate and erode the gastric mucosa and may increase acid secretion. | Contributes to mucosal damage and can exacerbate ulcer symptoms. |
Clinical Presentation of PUD
The hallmark symptom of peptic ulcer disease is epigastric pain, often described as burning, gnawing, or aching. The pain is typically related to meals: it may improve with food in duodenal ulcers but worsen with food in gastric ulcers. Other symptoms can include bloating, nausea, vomiting, loss of appetite, and unintentional weight loss.
A key differentiator in pain patterns: Duodenal ulcer pain often improves with food, while gastric ulcer pain may worsen with food.
Diagnosis of PUD and H. pylori
Diagnosis typically involves a combination of clinical assessment and investigations. Endoscopy (gastroscopy) is the gold standard, allowing direct visualization of the ulcer and the ability to take biopsies for H. pylori testing (histology, rapid urease test, or culture). Non-invasive tests for H. pylori include urea breath tests, stool antigen tests, and serological antibody tests.
The diagnostic pathway for PUD and H. pylori involves several steps. Initially, a patient presents with symptoms suggestive of PUD. Endoscopy is the preferred method for direct visualization and biopsy. Biopsies can be sent for rapid urease testing (CLO test), histology, or culture. Non-invasive methods like the urea breath test (UBT) or stool antigen test are also widely used, especially for confirming H. pylori eradication after treatment. Serological tests detect antibodies but are less useful for active infection or eradication confirmation.
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Management of PUD and H. pylori
Management focuses on eradicating H. pylori (if present), reducing gastric acid secretion, and promoting ulcer healing. This typically involves a combination of medications.
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Treatment regimens for H. pylori eradication usually involve a proton pump inhibitor (PPI) combined with two or more antibiotics (e.g., amoxicillin, clarithromycin, metronidazole). Acid suppression is achieved with PPIs or H2-receptor antagonists. Lifestyle modifications, such as smoking cessation and avoiding NSAIDs, are also crucial.
Proton Pump Inhibitors (PPIs) and H2-receptor antagonists.
Complications of PUD
Complications can be serious and include bleeding (hematemesis, melena), perforation (leading to peritonitis), and gastric outlet obstruction. These complications often require urgent surgical or endoscopic intervention.
Recognizing the signs of PUD complications is critical for timely intervention and patient survival.
Learning Resources
Provides a comprehensive overview of stomach ulcers, including causes, symptoms, diagnosis, and treatment from a UK health perspective.
Details on H. pylori infection, its link to ulcers, symptoms, diagnosis, and treatment options, aligned with UK healthcare guidelines.
An in-depth medical resource covering the pathophysiology, clinical presentation, diagnosis, and management of peptic ulcer disease.
A detailed medical overview of H. pylori infection, including epidemiology, microbiology, clinical manifestations, and treatment strategies.
A highly respected clinical resource offering detailed, evidence-based information on PUD, suitable for healthcare professionals.
Comprehensive information on the epidemiology, transmission, and pathogenesis of H. pylori infection from a leading medical database.
A clear and concise video explaining the pathophysiology, symptoms, and diagnosis of peptic ulcer disease.
An animated video that breaks down H. pylori infection, its mechanisms, and its impact on the stomach.
Patient-friendly information from Mayo Clinic on peptic ulcers, covering causes, symptoms, diagnosis, and treatment.
An informative article from the ACG explaining the relationship between H. pylori and peptic ulcers, written for a general audience.