Introduction

Peptic ulcer disease may be defined as ulceration in the stomach or duodenum. It is worth remembering that many patients are managed with the clinical diagnosis of 'dyspepsia' as opposed to the endoscopic diagnosis of peptic ulcer disease.

Epidemiology

  • Incidence: 75.00 cases per 100,000 person-years
  • Peak incidence: 40-50 years
  • Sex ratio: more common in males 1.3:1
Condition Relative
incidence
Gastro-oesophageal reflux disease66.67
Peptic ulcer disease1
<1 1-5 6+ 16+ 30+ 40+ 50+ 60+ 70+ 80+

Aetiology

Risk factors
  • Helicobacter pylori is associated with the majority of peptic ulcers:
    • 95% of duodenal ulcers
    • 75% of gastric ulcers
  • drugs:
    • NSAIDs
    • SSRIs
    • corticosteroids
    • bisphosphonates
  • Zollinger-Ellison syndrome: rare cause characterised by excessive levels of gastrin, usually from a gastrin secreting tumour
  • the role of alcohol and smoking is not clear

Pathophysiology

In peptic ulcer disease there is an imbalance between protective factors (e.g. mucous production, blood flow) and factors that promote damage (e.g. Helicobacter pylori, gastric acid).

Clinical features

Features
  • epigastric pain
  • nausea
  • duodenal ulcers
    • more common than gastric ulcers
    • epigastric pain when hungry, relieved by eating
  • gastric ulcers
    • epigastric pain worsened by eating

Investigations

Investigation
  • Helicobacter pylori should be tested for
    • either a Urea breath test or stool antigen test should be used first-line

Management

Management
  • if Helicobacter pylori is negative then proton pump inhibitors (PPIs) should be given until the ulcer is healed
  • if Helicobacter pylori is positive then eradication therapy should be given

Complications