Peptic Ulcer Disease — Viva

Q1: DU vs GU (2 min)

• DU: food-relieved, nocturnal, weight gain, ~never malignant
• GU: food-worsened, weight loss, always biopsy, confirm healing OGD^[1]

Q2: H. pylori pathogenesis (2 min)

• Urease → ammonia cloud; CagA/VacA virulence; antral gastritis → acid dysregulation
• NSAIDs: COX-1 inhibition → prostaglandin loss → mucus/bicarbonate failure^[1]

Q3: Perforation management (3 min)

• Board-like abdomen, free gas → ABC, NG, IV antibiotics, IV PPI, Graham patch^[1]
• Anterior free perforation vs sealed perforation needing CT if equivocal^[1]

Q4: Bleeding ulcer (3 min)

• Posterior DU → GDA; dual endoscopic therapy; PPI 80 mg then 8 mg/h × 72 h^[3]
• Restrictive transfusion; IR or under-run if fails; Glasgow-Blatchford vs Rockall roles^[2]

Q5: Eradication & resistance (3 min)

• Triple 14 d if clarithromycin resistance low; bismuth quadruple if high (much of India)^[4][5]
• Test of cure UBT/stool Ag; off PPI 2 weeks; not serology^[4]

Q6: GOO (2 min)

• Succussion splash, old food vomit; hypokalaemic hypochloraemic metabolic alkalosis
• NG, saline+K, PPI, OGD biopsy, dilatation vs surgery; exclude malignant GOO^[1]

Q7: Historical acid surgery & dumping (2 min)

• Truncal vagotomy + drainage; HSV; Billroth I/II
• Early dumping (osmotic/vasomotor) vs late dumping (hypoglycaemia)^[1]

Q8: ZES (2 min)

• Multiple/recurrent/jejunal ulcers + diarrhoea; fasting gastrin + low pH; MEN1 screen; high-dose PPI^[6]

References6ShowHide

1. [1]Tarasconi A, Coccolini F, Biffl WL, et al. Perforated and bleeding peptic ulcer: WSES guidelines World J Emerg Surg, 2020.PMID 31921329
2. [2]Laine L, Barkun AN, Saltzman JR, et al. ACG Clinical Guideline: Upper Gastrointestinal and Ulcer Bleeding Am J Gastroenterol, 2021.PMID 33929377
3. [3]Lau JY, Sung JJ, Lee KK, et al. Effect of intravenous omeprazole on recurrent bleeding after endoscopic treatment of bleeding peptic ulcers N Engl J Med, 2000.PMID 10922420
4. [4]Fallone CA, Chiba N, van Zanten SV, et al. The Toronto Consensus for the Treatment of Helicobacter pylori Infection in Adults Gastroenterology, 2016.PMID 27102658
5. [5]Dutta S, Jain S, Das K, et al. Primary antibiotic resistance of Helicobacter pylori in India over the past two decades: A systematic review Helicobacter, 2024.PMID 38415810
6. [6]Rossi RE, et al. Gastrinoma and Zollinger Ellison syndrome: A roadmap for the management between new and old therapies World J Gastroenterol, 2021.PMID 34629807