Peptic Ulcer Disease (PUD)

What is Peptic Ulcer Disease?
Statistics on Peptic Ulcer Disease
Risk Factors for Peptic Ulcer Disease
Progression of Peptic Ulcer Disease
How is Peptic Ulcer Disease Diagnosed?
Prognosis of Peptic Ulcer Disease
How is Peptic Ulcer Disease Treated?
Peptic Ulcer Disease References
Drugs/Products Associated with Peptic Ulcer Disease

What is Peptic Ulcer Disease?

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.

Anatomy of the gastrointestinal system

Statistics on 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.

Risk Factors for Peptic Ulcer Disease

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 of Peptic Ulcer Disease

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.

How is Peptic Ulcer Disease Diagnosed?

The only labaratory finding may be of iron-deficiency anaemia.

Prognosis of Peptic Ulcer Disease

Peptic ulcer disease (PUD) With removal of the causative factor when appropriate (e.g. NSAID use) and the use of appropriate treatment - H. Pylori eradication therapy, Proton Pump Inhibitors, most peptic ulcers heal within a few weeks.

The complications of PUD can be associated with significant morbidity, and acute presentations with haemorrhage and perforation can be associated with significant mortality (up to 25%), however, with the early introduction of appropriate treatment these are now much less common.

PUD is not considered to be associated with a risk of cancer, although cancers can ulcerate and be mistaken for peptic ulcers.

How is Peptic Ulcer Disease Treated?

The mainstay of treatment is eradicating H. Pylori when present and treating the cause - e.g. stopping of NSAID use if excessive.

Ulcers associated with H. pylori

Eradicating H. pylori is associated with healing rates of over 90% and prevents re-occurrence unless reinfection occurs. The usual treatment is "triple therapy" - with a proton pump inhibitor, and two antibiotics against H. Pylori.

Ulcers not associated with H. pylori

Usually associated with excessive use of NSAIDS. Therefore, stop NSAID or other causative agents, if possible and give acid suppressing drugs (H2 blocker or PP inhibitor). This will heal 80%-90% of ulcers over two months.

Antacids and antireflux methods (decrease weight, stop smoking, decrease alcohol, raise bed head, small regular meals, avoid hot drinks and eating less than 3 hours before bed) may also be used to compliment the above medical management.

Complications (haemorrhage, perforation, gastric outlet obstruction) are managed in hospital with appropriate resuscitation, and definitive management which usually requires surgery and/or endoscopy.

Peptic Ulcer Disease References

Braunwald E, Fauci AS, Kasper DL, et al. Harrison's Principles of Internal Medicine (15th edition). New York: McGraw-Hill Publishing; 2001.
Cotran RS, Kumar V, Collins T, Robbins SL. Robbins Pathologic Basis of Disease (6th edition). Philadelphia: WB Saunders Company; 1999.
Davidson S, Haslett C. Davidson's Principles and Practice of Medicine (19th edition). Edinburgh: Churchill Livingstone; 2002.
Hurst JW (ed). Medicine for the Practicing Physician (4th edition). Norwalk, CT. Appleton and Lange; 1996.
Kumar P, Clark M. Clinical Medicine (5th edition). Edinburgh: WB Saunders; 2002.
Longmore M, Wilkinson IB. Oxford Handbook of Clinical Medicine (5th edition). Oxford: Oxford University Press; 2001.
McLatchie GR, Leaper DJ (eds). Oxford Handbook of Clinical Surgery (2nd edition). Oxford: Oxford University Press; 2002.
National Institute of Diabetes and Digestive and Kidney Diseases. Peptic ulcer [online]. Bethesda, MD: MedlinePlus. Available from: URL link
Raftery AT. Churchill's Pocketbook of Surgery. Edinburgh: Churchill Livingsone; 2001.
Tjandra JJ, Clunie GJA, Thomas RJS (eds). Textbook of Surgery (2nd edition). Melbourne: Wiley-Blackwell; 2001.