Review Question - QID 101086

Based on the patient's presentation and the finding of a duodenal ulcer, the most likely cause is an H. pylori infection (most common cause of peptic ulcer disease). Therefore, antibiotics would be the best treatment.

H. pylori is a spiral-shaped bacterium that is able to colonize the mucus of gastric cells. This can lead to areas of compromised mucus protection. H. pylori infection is also associated with increased production of acid. Combined, this can mediate the formation of peptic ulcers. Initial treatment includes the use of antibiotics, which also helps to eradicate the subsequent symptoms of peptic ulcer disease. The goal of antibiotic treatment is the elimination of the bacteria from the stomach.

Loyd et al. discuss the evaluation and management of functional (non-ulcer) dyspepsia. They define functional dyspepsia as a postprandial fullness with early satiety with concomitant epigastric pain or burning in the absence of a causative structural disease. There is an increased incidence of H. pylori infection in patients with functional dyspepsia. Testing for and treating H. pylori infection have become integral to the diagnostic management of functional dyspepsia.

Cekin et al. discuss H. pylori in nonmalignant diseases. Prophylactic eradication of H. pylori is associated with reduced risk of both gastric and duodenal ulcers. The most specific test for detecting H. pylori infection is culture of biopsy specimens, although serology and rapid urease test are also commonly used. Interestingly, although the relationship between GERD (gastroesophageal reflux disease) and H. pylori is very controversial, evidence suggests that the eradication of H. pylori appears to significantly improve GERD symptoms.

Illustration A depicts an overview image of duodenal and gastric ulcers. Illustration B shows an actual image of a duodenal ulcer seen on an upper GI endoscopy (EGD - esophagogastroduodenoscopy). Illustration C depicts the pathophysiology of H. pylori.

Incorrect Answers:
Answer 2: Though NSAID use can mediate peptic ulcer disease, NSAID use is not the most common cause of peptic ulcer disease.
Answer 3: Surgical resection might prove useful in those suffering from Zollinger-Ellison syndrome, however Zollinger-Ellison syndrome is not the most common cause of peptic ulcer disease.
Answer 4 and 5: Though cimetidine (H2 receptor blocker) and omeprazole (blocks H release) would be effective in lowering the acidity of the stomach, stomach acidity itself is not the most likely cause of peptic ulcer disease.