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Gastric ulcer - Coggle Diagram
Gastric ulcer
Aetiology and Risk Factors
Helicobacter pylori infection
NSAID use
Aspirin
Smoking
Alcohol
Severe physiological stress
Previous ulcer history
Clinical Presentation
Epigastric pain
Pain often worsens after eating
Nausea and vomiting
Early satiety
Bloating
Weight loss
Possible asymptomatic presentation
Management
PPI therapy
Eradication of H. pylori
Stop NSAIDs where possible
Avoid smoking
Reduce alcohol
Endoscopic haemostasis if bleeding
Surgery or interventional radiology for selected complications
Patient Education and Safety Netting
Medication adherence
Avoid NSAIDs unless advised
Smoking cessation
Recognise bleeding symptoms
Seek urgent help for severe abdominal pain
Report persistent vomiting or weight loss
Pathophysiology
Imbalance between mucosal protection and acid injury
Reduced mucus and bicarbonate protection
Gastric acid and pepsin damage
H. pylori-associated inflammation
Impaired mucosal healing
Blood tests
FBC
U&Es
Ferritin/iron studies
Gastric biopsy
Exclude malignancy
Test for H. pylori
H. pylori testing
Urea breath test
Stool antigen test
OGD (gastroscopy)
Consider CT if complications suspected
Complications
Upper GI bleeding
Haematemesis
Melaena
Iron-deficiency anaemia
Perforation
Acute abdomen
Peritonitis
Gastric outlet obstruction
Penetration into adjacent organs
Gastric malignancy / underlying ulcerated cancer
Monitoring and Follow-up
Repeat OGD to confirm healing
Repeat biopsy where indicated
Confirm H. pylori eradication
Review ongoing NSAID requirement
Monitor haemoglobin if bleeding
Pharmacology
Proton Pump Inhibitors (PPIs)
Omeprazole, lansoprazole
Inhibit proton pumps
Reduce gastric acid and promote healing
H. pylori Eradication
PPI + antibiotics
Amoxicillin, clarithromycin or metronidazole
Eradicate infection and prevent recurrence
H2-Receptor Antagonists
Famotidine
Reduce gastric acid secretion
Mucosal Protection
Sucralfate – protects ulcer lining
Misoprostol – prevents NSAID-induced ulcers
Antacids
Gaviscon, calcium carbonate
Neutralise acid; symptomatic relief
Prognosis
Generally good with treatment
Healing following acid suppression
Recurrence if H. pylori persists
Increased complications if untreated