Peptic

Peptic ulcer disease (PUD) is a break in the inner lining of the stomach, the first part of the small intestine, or sometimes the lower esophagus. An ulcer in the stomach is known as a gastric ulcer, while one in the first part of the intestines is a duodenal ulcer. The most common symptoms are waking at night with upper abdominal pain or upper abdominal pain that improves with eating. The pain is often described as a burning or gnawing feeling.

Causes

The main causes of PUD are Helicobacter pylori infection and nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen. Other less common causes include tobacco smoking, stress due to serious illness, Behcet disease, Zollinger-Ellison syndrome, Crohn disease and liver cirrhosis, among others. Older people are more sensitive to the ulcer-causing effects of NSAIDs. The diagnosis is typically suspected due to the presenting symptoms with confirmation by either endoscopy or barium swallow.

Treatment

Peptic ulcers are treated with lifestyle changes and medicines to decrease the amount of acid in your stomach. These include proton pump inhibitors (PPIs) and H2 blockers. When caused by H. pylori infection, it can be cured with a combination of antibiotics and proton pump inhibitors. If the ulcers are caused by NSAIDs, they can be cured by stopping the NSAIDs, taking a PPI, and possibly taking an antibiotic. Despite treatment, about 15% of people fail to improve and may need surgery, which generally involves direct closure of the ulcer with or without pyloroplasty or vagotomy.

Epidemiology

Peptic ulcer disease is common, affecting millions of people annually. The risk of death from a peptic ulcer disease is around 1%. Duodenal ulcers are four times more common than gastric ulcers. It is estimated that 5-10% of people develop a peptic ulcer at some point in their life.

See also

• Gastritis
• Gastroenteritis
• Stomach cancer

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