Peptic ulcer disease

Abstract

Peptic ulcer disease (PUD) is a chronic disease characterized by defects in the inner lining of the gastrointestinal (GI) tract because of gastric acid secretion or pepsin, the major digestive enzyme. The ulcer penetrates through the layers of the mucosa, extending into the submucosa or muscularis propria. This is confirmed on endoscopy. It usually occurs in the stomach and proximal duodenum and may involve the lower esophagus, distal duodenum or jejunum. Gastric and duodenal ulceration is collectively known as PUD. PUD has various causes. However, Helicobacter pylori-associated PUD and non-steroidal anti-inflammatory drug (NSAID) associated PUD account for most of the disease. The natural history of peptic ulcer ranges from healing without intervention to the development of complications and significant morbidity and mortality, such as bleeding and perforation. PUD remains an important cause of morbidity and health care costs. In the past, PUD was more common in men. Now, the prevalence is much lower, largely because of H.pylori eradication and the incidence is more even in the sexes. Today, testing for H.pylori is recommended in all patients with PUD. Most patients can be managed with proton pump inhibitor (PPI) based triple drug therapy.