Smoking n alcohol DONT CAUSE peptic ulcer, but they delay healing of already existing ulcers (hence, advise all patients with peptic ulcers to stop smokin n drinkin),
the mc cause of PUD (80-90% of DU n 70-80% of GU) is H.pylori; 2nd mcc= Nsaids.
the mcc of epigastric pain is non ulcer dyspepsia.
However, smokin n drinkin CAUSES gastritis.
Regarding Rx for peptic ulcer its more of a Step2 topic..but since u asked ill answer it FULLY, so that others may also benefit n step 1 takers also get a taste of how exciting it is to prepare for step 2(its all about rules in step 2...if this is there , then do this,or else do that...etc)...(unlike Step 1:sleepy
there is a protocol for management of peptic ulcer..it goes like this
the pt comes to ur clinic with epigastric pain...
FIRST: in his hx(exam ques stem) check for the presence of ANY of the following ALARM SX (age >45y; bleeding; anemia; weight loss; dysphagia, failed empirical treatment with PPIs)...
if ANY alarm sx is present....1st step is Upper GI Endoscopy (to rule out cancer through biopsy sample), if done, it also helps to visualise presence of ulcers..if seen test for h.pylori (serology/stool antigen/Urea breath test/ Biopsy)...if +ve..triple therapy (PPIs+Amoxicillin+Claithromycin)
THEN if NO Alarm Sx...first step is to EMPIRICALLY TREAT all pts with PPIs(if severe pain; note: all ppis have equal efficacy in controlling acid prodn) ORH2 blockers (if mild pain)
[Note:NEVER empirically treat H.Pylori, triple therapy is initiated ONLY after u prove that epigastric pain is due to ulcer, or u prove presence of h.pylori.]
If pt does not improve...endoscopy+ h.pylori biopsy if ulcers seen OR test for h.pylori..if +ve...triple therapy is started
If pt with proven ulcers with h. pylori not recovered ,or, recovered but sx reappear after triple therapy...check for eradication of h.pylori using stool Ag or Urea breath test (they may need repeat triple therapy if sx reappear after recovery, or, change in antibiotics to tetracyclins n metronidazole plus bismuth if h.pylori is not eradicated)
If still no improvement...workup for Zollinger Ellison after stopping PPIs (gastrin+acid output, or secretin test + endoscopy...etc)...
If all causes ruled out..Dx patient as having Non ulcer Dyspepsia, the most common cause of epigastric pain.
If PUD is Nsaid related...try to change to Cox2 inhibitors...Misoprostol is rarely used....instead, here use PPIs alone.
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