This refers to ulceration of gastric or duodenal mucosa that tends to be chronic and/or recurrent.
Clinical Features of Duodenal Ulcer
Duodenal ulcer has the following features:
Presents with epigastric pain that is typically nocturnal and also when the patient is hungry.
May present for the first time with complications.
There is a wide individual variation in presenting symptoms and in the foods that give pain or discomfort when eaten.
95% of duodenal ulcers are caused by Helicobacter pylori (H.pylori).
Clinical Features of Gastric Ulcer
Gastric ulcer presents with:
Epigastric pain that is worse after eating food.
Other symptoms are similar to those for duodenal ulcers.
Investigations
Stool for occult blood
Barium, meal
Upper GIT endoscopy, where available and biopsy gastric mucosa for H. pylori
Complications
Chronic blood loss may lead to iron deficiency anaemia, and acute bleeding results in haematemesis or melaena stool.
Management
Avoid any food that to the patient;s experience gives pain.
Avoid obviously acidic foods, e.g., Cola drinks.
Avoid gastric irritating drugs (NSAIDs).
Give magnesium-based antacids or combined magnesium-aluminum compounds, liquid preferred. Adjust dose to limit pain.
Eradicate H.pylori by triple therapy:
Omeprazole 20mg BD 14 days or cimetidine 20-40mg/kg/day
Clarithromycin 500 mg BD 14 days or metronidazole 15-20 mg/kg/day BD
Amoxicillin 25-50 mg/kg BD 14 days
Refer/consult if there is severe haemorrhage.
Make sure you stabilize the patient before transfer.
Infuse fluids/blood to maintain a normal pulse.
Continue to asses for any further loss of blood as evidenced by: Persistent tachycardia, postural hypotension, continuing haematemesis.
NOTE: Eradication of H.pylori leads to healing and most patients will not need long-term treatment. Complications will also be avoided.