349.2 🩺 國考版

349.2.1 高頻考點

349.2.1.1 PUD Etiology

• H. pylori (most worldwide)
• NSAIDs (most in developed)
• ZES
• Stress (ICU)
• Drugs

349.2.1.2 DU vs GU

• DU: pain relieved by food; weight gain; rarely malignant
• GU: pain worsened by food; weight loss; biopsy mandatory

349.2.1.3 Complications

• Bleeding (most common)
• Perforation
• Penetration
• Gastric outlet obstruction
• Malignancy (GU)

349.2.1.4 H. pylori Testing

• Urea breath test (preferred non-invasive)
• Stool antigen
• Biopsy + CLO test
• Histology
• Serology (less specific)

349.2.1.5 H. pylori Treatment (Updated 2024)

Quadruple Therapy (preferred): - Bismuth + PPI + tetracycline + metronidazole × 14 d

Triple Therapy (clarithromycin): - PPI + clarithromycin + amoxicillin × 14 d - Only if clarithromycin resistance < 15%

Vonoprazan-Based (FDA 2022): - Vonoprazan + amoxicillin (dual) or + clarithromycin (triple) - 14 d - Higher eradication

Verification: UBT or stool antigen 4+ weeks after, off PPI 2 weeks

349.2.1.6 NSAID-Induced PUD

• Stop NSAID if possible
• Switch to COX-2 selective
• PPI prophylaxis

349.2.1.7 Functional Dyspepsia

• Rome IV criteria
• PDS (postprandial distress) vs EPS (epigastric pain)
• H. pylori eradication
• PPI
• Prokinetics
• TCA/SSRI for refractory

349.2.1.8 Zollinger-Ellison Syndrome

• Gastrinoma
• MEN1 25%
• Multiple atypical ulcers
• Gastrin > 1000 + acidic pH
• High-dose PPI + surgical resection

349.2.2 易混淆比較

Feature	DU	GU
Pain timing	2-3 hr after meal; relieved	Worsened with food
Risk of malignancy	Rare	All need biopsy
H. pylori	70-95%	60-80%
Sleep	Night pain (2-3 AM)	Less

349.2.3 Special Topics

349.2.3.1 Common NSAID Pitfall

• Even short courses (< 1 week)
• High-dose chronic
• Concomitant ASA / anticoagulant
• Elderly
• Add PPI for prophylaxis

349.2.3.2 Penetrating Ulcer

• Pancreas (raise lipase)
• Biliary
• Liver
• Abscess

349.2.3.3 Refractory PUD Workup

• Confirm H. pylori eradication
• ZES workup
• NSAID use
• Smoking
• Malignancy

---