Peptic ulcer disease is when ulcers that go through the muscularis mucosae form in the gastrointestinal mucosa, presenting as burning epigastric pain relieved with oral intake. It is diagnosed with endoscopy and treated with acid suppression and addressing the cause of the ulcers (either H. pylori or NSAID overuse).

Pathophysiology

• Caused by H. pylori or NSAID overuse disrupting the mucosa’s ability to protect from gastric acid

Contextual Factors

• Smoking
• Zollinger-Ellison syndrome: excess secretion of gastrin due to gastrinoma
• Family history of duodenal ulcers

Clinical Manifestation

• Burning epigastric pain
• Relieved by food or antacids

Duodenal Ulcers

• Pain absent upon awakening but appears mid-morning
• Initially relieved by food until it is digested
• Pain awakens patient at night

Complications

• Hemorrhage
• Penetration and perforation of the stomach
  • Free air on x-ray or CT -> surgery
• Gastric outlet obstruction due to scarring or inflammation
• Stomach cancer - increased risk if caused by H. pylori

Diagnosis

• Upper endoscopy
  • Can distinguish between ulceration and stomach cancer
• H. pylori testing: urea breath test or stool antigen assays

Treatment

• Antacid
• H. pylori treatment:
  • Bismuth subsalicylate
  • Metronidazole
  • Tetracycline
• Lifestyle modification: smoking cessation, reduced alcohol consumption, eliminating exacerbating foods
• Surgery to repair perforations