Ulceration of the gastroduodenal mucosa that has tendency to be chronic and recurrent; can be duodenal or gastric.

Classified into:

  • Duodenal
  • Gastric
  • Pylori infections in GIT (95%).
  • Abnormality in secretion of gastric acid & pepsin.
  • Gastrinoma in ZES.
  • Psychological stress.
  • Cigarette smoking &/or alcohol consumption.
  • NSAIDs
  • Oral bisphosphonates e.g. alendronate
  • Immunosuppressants
  • Aspirin
  • Epigastric pain:
  • DU-typically at night and when hungry.
  • GU- worse with food.
  • Pain worse when lying down.
  • Bloating

N & V.

  • Hemorrhage
  • Perforation
  • Sub-phrenic collection (acc. of infected fluid btwn the diaphragm, liver and spleen)
  • Gastric outlet obstruction.
  • Increased risk of gastric ulcers.
  • Hematemesis.
  • Stool for occult blood.
  • Barium meal x-ray.
  • Stool for H.pylori antigen.
  • Endoscopy

Non-pharmacological + Nutritional:

  • Avoid foods that may increase acidity e.g. fatty foods, chili, sodas, and black tea/coffee.
  • Do not skip any meals.
  • Limit alcohol and cigarette smoking.
  • Bed rest in acute attacks.
  • Avoid gastric irritating drugs e.g. NSAIDs.

Pharmacological;

  • Triple therapy for H.pylori eradication: Omeprazole 20mg BD 14days + Clarithromycin 500mg BD 14days + amoxicillin 1g BD 14 days (MTZ/ tinidazole – less preferred due to higher resistance rates) + Omeprazole 20mg BD 1/12.
  • Mg-based antacids/Mg-Al compounds, liq preferred e.g. Maalox, Gaviscon, Milk of Magnesia. Max: 6 tabs/day.
  • If no response:  Cimetidine 800mg nocte for 4-6weeks then 400mg as maintenance.