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Peptic ulcer disease

Peptic ulcer disease

  • Peptic ulcer: a defect in the gastric or duodenal mucosa with a diameter of at least 0.5 cm and a depth that penetrates through the muscularis mucosae
  • Gastric ulcer: a peptic ulcer of the gastric mucosa, typically located along the lesser curvature in the transitional portion between the corpus and antrum
  • Duodenal ulcer: a peptic ulcer of the duodenal mucosa, usually located on the anterior or posterior wall of the duodenal bulb

Epidemiology

  • Incidence: ∼ 1 case/1,000 person-years [2]
  • Prevalence
  • Age: The median age of diagnosis is 18–30 years. 
  • Sex: ♂ = ♀

  • Etiology

  • Helicobacter pylori infection
  • Chronic NSAID use
    • Associated with a fourfold risk of developing PUD [9]
    • Increases the risk for complications of PUD
    • Acid hypersecretory states
    • Non-NSAID medications
    • Infections
    • Others
      • Radiation
      • Illicit drug use (e.g., cocaine, methamphetamine)
      • Systemic inflammatory diseases (e.g., Crohn disease, sarcoidosis)
      • Mechanical (e.g., foreign body, GI tract obstruction, postsurgical anatomy)

      • Clinical features


      • PUD may be asymptomatic or manifest with a variety of clinical features, e.g., general dyspepsia or complications such as perforation or bleeding.

        Asymptomatic PUD

        • Up to 70% of patients with peptic ulcers do not experience symptoms. [14][15]
        • Patients who take NSAIDs are more likely to have asymptomatic ulcers and present with complications of PUD.

        Symptomatic PUD

        • Abdominal pain
          • The most common symptom of PUD  [16]
          • Commonly located in the epigastrium 
          • Often described as “gnawing” or “burning”
          • Can be related to meal intake depending on the location of the ulcer (see “Clinical symptoms of gastric and duodenal ulcers”)
        • Other associated symptoms
          • Belching
          • Indigestion
          • Gastrointestinal reflux
          • Nausea and/or vomiting
          • Bloating/abdominal fullness


          • Gastric ulcer is associated with pain after light (weight loss) Gorging. Duodenal ulcer is associated with relief after massive (weight gain) Desserts.


      • Diagnostics

        Esophagogastroduodenoscopy (EGDH. 
      • pylori test

      • Treatment

      • Acid suppression medications and antacids   
      • Cytoprotective agents 
      • Antibiotics

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