Peptic ulcer

Forward- Related with MAG, DAG, MALToma

Risk factor- H.pylori, NSAID/aspirin, stress, gastrinoma, blood group O, HLA-B5, smoking, CRF, liver cirrhosis, hyperparathyroidism, COPD, systemic mastocytosis, renal transplantation

Presentation- Pain before meals and in the middle of the night , sudden breakthrough pain(perforation), hematemesis(bleeding), vomiting(gastric outlet obstruction)

Modified Johnson classification

TypeSiteEtiology
I (60%)Lesser curvatureMucosa damage
II (15%)gastric body + duodenumHCL↑
III (20%)PrepyloricHCL↑
IV (<10%)EC junctionMucosa damage
V (5%)any locationNSAID, aspirin

Diagnosis- Invasive(histologic, culture, rapid urease test), non-invasive(urease breath test, serum antibody, stool antigen)

Treatment 

1.H.pylori regimen

PPI+Clarithromycin+Metronidazole/amoxicillin for 14 days, Bismuth+PPI+Tetracycline+metronidazole

2.Sulcralfate– bind to ulcer up to 12hrs, 1g 1hr before meal and bedtime

3.Prostaglandin– misoprostol, 200ug qid, prevent ulcer caused by NSAID

4.PPI– Rabeprazole(20mg bid), lansoprazole(30mg bid), pantoprazole(40mg bid), esomeprazole(40mg qd), plateu reach at 4th day, became to normal after discontinuation over 3~5 days, duration 4~8weeks

5.H2 receptor antagonist- cimetidine(400mg qd)(antiandrogen, renal and hepatic, blood dyscrasia),ranitidine(150mg qd)(像cimetidine, 但副作用較少), famotidine(20mg qd)

6.Antacid– Al(constipation), Mg(diarrhea),Ca(milk alkali syndrome), 140mmol 1h and 3h after eating and bedtime

Complication- Bleeding, hematemesis, melana(60ml, 7days), perforation, obstruction

Published by Steve Johnson

I am a doctor who like to organise knowledges and share ideas with others. As a doctor, a lot of knowledges influx everyday and need some patient to organise and absorb. Here was my notes to share with you and hope to save your time to know it.

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