definition and etiologies of peptic ulcer disease

peptic ulcer disease

(20-60%; duodenal>gastric) (Am J Gastro 2021;116:899)

• definition and etiologies of peptic ulcer disease
• clinical manifestations of peptic ulcer disease
• diagnostic studies of peptic ulcer disease
• treatment of peptic ulcer disease
• GI prophylaxis if taking ASA and nonsteroidal anti-inflam drug

Treatment

• PPI: 40 mg PO or IV BID

Endoscopic therapy

• epi inj + bipolar cautery or hemoclip.
• Bx for H. pylori and treat if ⊕.

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High-risk (for rebleeding) ulcer

• arterial spurting, adherent clot, visible vessel.
• Endo Rx, IV PPI × 72 h post EGD, then → Δ to high-dose oral PPI.
• If fail, arteriography w/ embolization; surgery (last resort).

Intermediate-risk ulcer

• oozing, in o/w stable Pt. Endo Rx, can Δ to oral PPI after EGD and observe 24-48 h.

Low-risk ulcer

clean-based or flat. Oral PPI & discharge.

Hold anticoag & antiplatelet Rx until hemostasis; can resume after hemostasis & PPI on board (Endoscopy 2015;47:a1)