Peptic ulcer disease

Regarding the diagnosis and management of peptic ulcer disease, which one of the

following statements is CORRECT?

a) In the UK, gastric ulcers are, overall, more common than duodenal ulcers

b) Alcohol consumption is an independent risk factor for peptic ulcer disease

c) Peptic ulcers, almost universally, present with pain as one of the clinical features

d) The presence of night-pain tends to suggest a duodenal rather than gastric ulcer

e) A perforated peptic ulcer necessitates urgent laparotomy

Answer: d

Explanation

One hundred years ago peptic ulcers were likely to be gastric and affect young female patients. More recently patients presenting with peptic ulcers (in the UK) are likely to be elderly, from lower socioeconomic groups and have a duodenal ulcer. Duodenal ulcers, especially in the elderly, can be completely painless and present with anaemia, upper gastrointestinal bleeding or perforation. Night-pain, as a presenting complaint, does tend to indicate a duodenal rather than gastric ulcer. The epigastric pain of both gastric and duodenal ulcers is relieved by eating or antacids thus these factors are not helpful in distinguishing the two. There is no proven link between alcohol consumption per se and peptic ulcers; in fact, ethanol may reduce the probability of developing duodenal ulcers. However, cirrhosis or chronic pancreatitis (often consequences of excessive drinking of alcohol) are associated with increased rates of peptic ulceration. The role of surgery in the management of perforated ulcers is unquestioned if peritonitis or pneumoperitoneum has developed; however, in the absence of these features, conservative management is an accepted strategy and not just in patients with high risk comorbidity.