Given the large number of hospitalizations and deaths from peptic ulcer disease every
year, it is not surprising that this remains a major topic tested on the boards. The most
common causes are Helicobacter pylori infection and NSAIDs.
Remember:
H. pylori is associated with the development of gastric adenocarcinoma
as well as MALT (mucosa-associated lymphoid tissue) lymphoma
Treatment for H. pylori consists of triple therapy – PPI, Amoxicillin, and
Clarithromycin (Metronidazole in Clarithromycin resistant areas)
Urea breath test and fecal antigen test are both sensitive for the detection
of H. pylori
Be able to recognize a patient with a perforated peptic ulcer! Look for a patient who is
hypotensive and tachycardic with absent bowel sounds and severe rebound
tenderness and guarding. Imaging will show free intraperitoneal air. Stat surgical
consultation is required!