Peptic Ulcer Disease (PUD) commonly involves the stomach and first part of the small bowel which is the duodenum. Most peptic ulcer disease is caused by the use of nonsteroidal anti-inflammatory drug and helicobacter pylori. Smoking and alcohol can predispose to PUD. Patient may experience heart burn, epigastric pain (pain just below breast bone), left hypochondrium (below left rib cage), nausea and bloating. In severe cases, it can cause black tarry stools (melaena) and hametemesis (vomiting blood). Patients with duodenal ulcers tend to have pain at night whereas gastric ulcers sufferers tend to have pain triggered by food.
Helicobacter pylori gastritis is more common in the adult population. Treatment with proton pump inhibitors coupled with 2 antibiotics for 1 week is usually effective in eliminating the bacteria. NSAIDs induced ulcers is common. Patients should be refrained from using NSAIDs (aspirin, ibuprofen) if there is a clear history that NSAIDs causing the ulcer. Anti-secretory agents including anti histamine H2 receptor antagonist (ranitidine) or proton pump inhibitors (omeprazole, lansoprazole and esopmeprazole) for 4 weeks is usually required.
Gastroscopy is indicated for patients who do not response to medical treatment. It allows detailed mucosal assessment checking for erosive oesophagitis, gastric ulcer, duodenal ulcers.