Peptic Ulcer Disease (PUD)

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What is Peptic Ulcer Disease?

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Peptic ulcer disease occurs mainly in the stomach or proximal duedenum.

Rarely, however, peptic ulcers can also occur in the oesophagus, jejunum (in Zollinger Ellison syndrome) or sometimes in a Meckel's diverticulum.

A: Stomach
B: Duodenum
C: Oesophagus

Who gets Peptic Ulcer Disease?

Peptic ulcers are common, occurring in some 10-15% of the population at any one time, with duodenal ulcers being four times more common than gastric ulcers. PUD is more common in men (four times) and more common in elderly people. Ulcer rates are declining for young men and increasing for older individuals - since non-steroidal anti-inflammatory drugs (NSAIDS) are becoming a more prevalent cause with the other major cause, Helcobacter pylori infection being readily treated.

Predisposing Factors

The two main causes of PUD are H. pylori infection and prolonged NSAID use. Peptic ulceration is also associated with smoking (impairs mucosal healing), excess alcohol hyperparathyroidism/ hypercalcaemia, Zollinger Ellison syndrome, excessive corticosteroid use, and stress.

Progression

Patients may present with the clinical features listed. Peptic ulcers are chronic and recurrent lesions. Untreated, peptic ulcers can take around 15 years to heal but they heal quickly with present day therapies. Treating the cause or removing the exacerbating factor should be curative and patients can resume normal activity. The most important complications are perforation of the ulcer, obstruction due to excessive growth of fibrous tissue with stricture formation, and haemorrhage. These acute complications can be serious and require immediate emergency surgery.

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