Peptic Ulcer Disease in Clinical Practice
Peptic ulcer disease refers to ulceration of the gastric or duodenal mucosa due to the
corrosive effects of gastric acid and pepsin. It is a common gastrointestinal disorder
encountered in medical practice. Medical students should understand the etiology,
pathophysiology, clinical features, complications, and management of peptic ulcer disease
because it remains a major cause of morbidity worldwide.
The two major forms are gastric ulcer and duodenal ulcer. The most important causes of
peptic ulcer disease are Helicobacter pylori infection and prolonged use of non-steroidal
anti-inflammatory drugs. Other contributing factors include smoking, alcohol consumption,
stress, and severe illness.
Helicobacter pylori is a gram-negative bacterium that colonizes the gastric mucosa and
disrupts mucosal defense mechanisms. NSAIDs reduce prostaglandin synthesis, thereby
reducing mucus and bicarbonate production and increasing susceptibility to mucosal injury.
Patients commonly present with epigastric pain or burning sensation. Duodenal ulcer pain
often improves after meals while gastric ulcer pain may worsen with meals. Other
symptoms include bloating, nausea, vomiting, and early satiety.
Complications of peptic ulcer disease include gastrointestinal bleeding, perforation, gastric
outlet obstruction, and penetration into adjacent organs. Upper gastrointestinal bleeding
may present with hematemesis or melena. Perforation presents with sudden severe
abdominal pain and signs of peritonitis.
Diagnosis involves history, physical examination, and investigations. Upper gastrointestinal
endoscopy is the gold standard investigation because it allows direct visualization and
biopsy. Tests for Helicobacter pylori include urea breath test, stool antigen test, and biopsy-
based methods.
Treatment involves eradication of Helicobacter pylori, acid suppression, and avoidance of
risk factors. Triple therapy commonly includes a proton pump inhibitor combined with
clarithromycin and amoxicillin or metronidazole. Proton pump inhibitors such as
omeprazole are highly effective in reducing acid secretion and promoting healing.
Patients should avoid NSAIDs when possible and stop smoking and excessive alcohol intake.
Dietary advice may also help symptom control. Surgery is rarely required today due to
effective medical therapy but may be necessary in complicated cases such as perforation or
uncontrolled bleeding.
Peptic ulcer perforation is a surgical emergency. Management includes resuscitation,
antibiotics, proton pump inhibitors, and surgical repair. Massive gastrointestinal bleeding
may require endoscopic intervention or surgery.
Peptic ulcer disease refers to ulceration of the gastric or duodenal mucosa due to the
corrosive effects of gastric acid and pepsin. It is a common gastrointestinal disorder
encountered in medical practice. Medical students should understand the etiology,
pathophysiology, clinical features, complications, and management of peptic ulcer disease
because it remains a major cause of morbidity worldwide.
The two major forms are gastric ulcer and duodenal ulcer. The most important causes of
peptic ulcer disease are Helicobacter pylori infection and prolonged use of non-steroidal
anti-inflammatory drugs. Other contributing factors include smoking, alcohol consumption,
stress, and severe illness.
Helicobacter pylori is a gram-negative bacterium that colonizes the gastric mucosa and
disrupts mucosal defense mechanisms. NSAIDs reduce prostaglandin synthesis, thereby
reducing mucus and bicarbonate production and increasing susceptibility to mucosal injury.
Patients commonly present with epigastric pain or burning sensation. Duodenal ulcer pain
often improves after meals while gastric ulcer pain may worsen with meals. Other
symptoms include bloating, nausea, vomiting, and early satiety.
Complications of peptic ulcer disease include gastrointestinal bleeding, perforation, gastric
outlet obstruction, and penetration into adjacent organs. Upper gastrointestinal bleeding
may present with hematemesis or melena. Perforation presents with sudden severe
abdominal pain and signs of peritonitis.
Diagnosis involves history, physical examination, and investigations. Upper gastrointestinal
endoscopy is the gold standard investigation because it allows direct visualization and
biopsy. Tests for Helicobacter pylori include urea breath test, stool antigen test, and biopsy-
based methods.
Treatment involves eradication of Helicobacter pylori, acid suppression, and avoidance of
risk factors. Triple therapy commonly includes a proton pump inhibitor combined with
clarithromycin and amoxicillin or metronidazole. Proton pump inhibitors such as
omeprazole are highly effective in reducing acid secretion and promoting healing.
Patients should avoid NSAIDs when possible and stop smoking and excessive alcohol intake.
Dietary advice may also help symptom control. Surgery is rarely required today due to
effective medical therapy but may be necessary in complicated cases such as perforation or
uncontrolled bleeding.
Peptic ulcer perforation is a surgical emergency. Management includes resuscitation,
antibiotics, proton pump inhibitors, and surgical repair. Massive gastrointestinal bleeding
may require endoscopic intervention or surgery.
