• Ulceration of gastric or duodenal mucosa due to acid/pepsin imbalance
• Common causes:
o H. pylori infection (duodenal > gastric)
o NSAIDs (gastric > duodenal)
• Duodenal ulcers: pain relieved by food, more common
• Gastric ulcers: pain worsened by food, higher malignancy risk
• Complications: bleeding, perforation, gastric outlet obstruction
• Diagnosis: OGD + biopsy (especially for gastric ulcers to exclude malignancy)
• Treatment:
o PPI
o H. pylori eradication: triple therapy (PPI + clarithromycin + amoxicillin/metronidazole)
• Gastrin-secreting tumour (gastrinoma) → excess gastric acid
• Location: pancreas or duodenum
• Features: refractory peptic ulcers, diarrhoea, multiple ulcers
• Associated with MEN1
• Diagnosis:
o ↑ fasting gastrin
o Confirm with secretin stimulation test
o Localise with somatostatin receptor imaging
• Treatment: high-dose PPI ± surgical resection
• Most commonly adenocarcinoma
• Risk factors: H. pylori, smoking, high salt/nitrate diet, atrophic gastritis, pernicious anaemia
• Features: weight loss, epigastric pain, early satiety, Virchow’s node (left supraclavicular), acanthosis nigricans
• Diagnosis: OGD + biopsy
• Staging: CT, endoscopic ultrasound, laparoscopy
• Treatment: surgery ± chemotherapy
• H. pylori gastritis: chronic active inflammation; risk of ulcers, cancer
• Autoimmune gastritis:
o Antibodies against parietal cells and intrinsic factor
o Leads to B12 deficiency (pernicious anaemia)
o Associated with ↑ risk of gastric cancer
• Chemical gastritis: alcohol, NSAIDs, bile reflux
• Rapid gastric emptying post-gastrectomy or vagotomy
• Early dumping: fluid shift → abdominal pain, diarrhoea, hypotension
• Late dumping: reactive hypoglycaemia due to insulin surge
• Treatment: dietary changes (small, frequent meals, avoid high-sugar foods)
• Vitamin B12 deficiency: loss of intrinsic factor → megaloblastic anaemia
• Iron deficiency: ↓ acid affects iron absorption
• Small bowel bacterial overgrowth (SIBO): due to altered motility/anatomy
o Features: bloating, diarrhoea, malabsorption
o Dx: breath test
o Rx: antibiotics (e.g. rifaximin)
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Author & Educational Disclaimer
Author:
Dr Phillip Cockrell BM FRCP DipClinEd
Dr Phillip Cockrell is a UK Consultant Physician in Internal Medicine, currently working at Queen Alexandra Hospital, Portsmouth University Hospitals NHS Trust. He has previously worked as a registrar across Intensive Care Medicine, Gastroenterology, Cardiology, Stroke Medicine, Acute Medicine, and Respiratory Medicine.
He has held senior leadership roles including Associate Clinical Director of the Acute Medical Unit, Clinical Director of Internal Medicine, and Chief of Medicine. Dr Cockrell has over 15 years’ experience in postgraduate medical education, having lectured extensively across the MRCP syllabus and contributed to MRCP revision teaching and course development.
Dr Cockrell holds a Bachelor of Medicine (BM), Fellowship of the Royal College of Physicians (FRCP), and a Diploma in Clinical Education (DipClinEd). His teaching approach is based on structured consolidation of complex medical topics to support efficient and effective revision for postgraduate examinations.
Purpose of this content:
The material on this page is intended solely for educational purposes to support revision for the MRCP (UK) Part 1 examination. It reflects examination-relevant principles of internal medicine and is designed to aid learning and pattern recognition.
Medical disclaimer:
This content is designed for postgraduate medical examination revision and does not constitute medical advice, diagnosis, or treatment guidance and must not be used as a substitute for professional clinical judgement, local guidelines, or specialist consultation. Clinical decisions should always be made in the context of individual patient circumstances and current national guidance.
