What is it?
What is peptic ulcer disease?
An erosion and/or break in the gastric/duodenal mucosa caused by acid (Narayanan et al., 2018).
Which bacteria causes most ulcers?
H. pylori (Malik et al., 2023).
Classic symptom of PUD?
Burning epigastric (upper GI) pain (Malik et al., 2023).
Primary affected organs in PUD?
Stomach/duodenum. GI tract lining (Malik et al., 2023).
What assessments are important with PUD?
Location of pain, bowel sounds and abdominal tenderness (Malik et al., 2023)
What types of ulcers are caused by PUD?
Gastric ulcers and duodenal ulcers (Narayanan et al., 2018).
How do NSAIDs contribute to PUD?
NSAIDs block prostaglandins, which decreases the mucosal lining protection (Narayanan et al., 2018).
When would duodenal ulcer pain occur?
2-3 hours after eating. Food relieves symptoms ((American College of Gastroenterology, 2021).
What happens if an ulcer perforates?
Creates a hole in the stomach or intestinal wall, leaking contents into the abdomen and causing peritonitis which can lead to eventual sepsis (Malik et al., 2023).
What vital sign changes suggest GI bleeding?
Increased heart rate and decreased blood pressure (Malik et al., 2023).
What causes the mucosal break down?
Acid and inflammation lead to a disruption of the barrier (Malik et al., 2023).
What lifestyle risks increase the likelihood ulcers?
Smoking and alcohol use (American College of Gastroenterology, 2021).
When would gastric ulcer pain occur?
Pain occurs with food. Patients typically avoid eating, which can lead to weight loss (American College of Gastroenterology, 2021).
How can PUD affect the cardiovascular system?
Ulcers can erode blood vessels, causing slow bleeding over time or acute hemorrhage (Malik et al., 2023).
What GI physical findings suggest complications in PUD?
Rigid abdomen, rebound tenderness and guarding. Board-like abdomen is classic sign of perforation and peritonitis (Narayanan et al., 2018).
What is the most common cause of PUD?
H. pylori infection (Narayanan et al., 2018).
Most at risk groups for PUD?
Older adults, corticosteroid users and NSAID users (American College of Gastroenterology, 2021).
High alert/severe symptoms that require intervention?
Hematemesis (vomiting blood), melena (black, tarry stools) and severe sudden pain (possible perforation) (American College of Gastroenterology, 2021).
What long term impact can H. pylori infection have?
Increased risk of gastric cancer, due to chronic inflammation leading to atrophy, metaplasia and dysplasia (Narayanan et al., 2018).
What diagnostic test can assist in proper diagnosing of PUD?
CBC (looking for anemia), fecal occult blood test (GI bleed), H. pylori breath or stool test, endoscopy (best diagnostic test for PUD) (Narayanan et al., 2018).
What is the second most common cause of PUD?
Chronic NSAID use (Narayanan et al., 2018).
Foods that worsen PUD?
Coffee, acidic foods, alcohol, caffeine (American College of Gastroenterology, 2021).
What are some other symptoms commonly associated with PUD?
Nausea, bloating and feeling full quickly (American College of Gastroenterology, 2021).
What nervous system pathways are involved in ulcer pain?
Vagal and enteric nerve stimulation (Wu et al., 2016).
What is the first line treatment for PUD?
Proton pump inhibitors, H. pylori eradication therapy and discontinuation of NSAIDs (Narayanan et al., 2018) .
References
American College of Gastroenterology. (2021). Peptic ulcer disease . American College of Gastroenterology. https://gi.org/topics/peptic-ulcer-disease/
Malik, T. F., Singh, K., & Gnanapandithan, K. (2023). Peptic Ulcer Disease. National Library of Medicine; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK534792/
Narayanan, M., Reddy, K. M., & Marsicano, E. (2018). Peptic Ulcer Disease and Helicobacter pylori infection. Missouri Medicine, 115(3), 219. https://pmc.ncbi.nlm.nih.gov/articles/PMC6140150/
Wu, S.-C., Chen, W. T.-L., Fang, C.-W., Muo, C.-H., Sung, F.-C., & Hsu, C. Y. (2016). Association of vagus nerve severance and decreased risk of subsequent type 2 diabetes in peptic ulcer patients. Medicine, 95(49), e5489. https://doi.org/10.1097/md.0000000000005489