Peptic Ulcer Disease

Peptic ulcer disease (PUD) refers to open sores that develop in the lining of the stomach or duodenum. Ulcers form when acid, bile, or digestive enzymes damage the protective mucosal barrier. Common causes include Helicobacter pylori infection, chronic NSAID use, severe reflux, and stress-related mucosal injury. Symptoms range from burning pain to bleeding or obstruction, requiring prompt evaluation.

Major causes include H. pylori infection, NSAID or aspirin use, acid overproduction, bile reflux, smoking, alcohol, and stress-related mucosal injury. Less common causes include Zollinger–Ellison syndrome, severe GERD, and postsurgical changes.

Risk factors include chronic NSAID use, H. pylori infection, smoking, alcohol use, stress, severe reflux, and certain medications. Patients with foregut disorders or anatomical defects may be more susceptible.

Ulcers cause inflammation, pain, and erosion of the stomach or duodenal lining. Severe cases may lead to bleeding, perforation, or obstruction. Chronic ulcers can cause anemia, weight loss, and persistent digestive discomfort.

Complications include bleeding, perforation, gastric outlet obstruction, anemia, severe pain, and infection. Untreated ulcers may lead to significant morbidity and require urgent intervention.

Symptoms include burning or gnawing abdominal pain, nausea, vomiting, bloating, early fullness, dark stools, or vomiting blood. Pain may improve or worsen with eating depending on ulcer location.

Diagnosis is made through endoscopy, which allows direct visualization and biopsy. Additional testing may include H. pylori testing, imaging, and evaluation for acid overproduction or bile reflux.

Conditions that mimic PUD include gastritis, GERD, functional dyspepsia, biliary disease, pancreatitis, esophageal ulcer, and malignancy.

Lifestyle strategies include avoiding NSAIDs, reducing alcohol and smoking, eating smaller meals, avoiding trigger foods, and managing stress. Treating underlying reflux may reduce ulcer recurrence.

Treatment includes acid suppression therapy, H. pylori eradication, mucosal protective agents, and management of underlying causes such as bile reflux or severe GERD. Complicated ulcers may require endoscopic or surgical intervention.

Seek evaluation if you experience persistent abdominal pain, nausea, vomiting, dark stools, or symptoms that do not improve with medication.

Treatment is recommended when ulcers cause pain, bleeding, anemia, or when underlying causes such as H. pylori or NSAID use are present.

Long-term outcomes depend on eliminating underlying causes and maintaining acid control. Ongoing follow-up helps prevent recurrence.

Most ulcers heal with proper treatment. Recurrent or complicated ulcers require evaluation for underlying foregut disorders or acid overproduction.

Dr. Nestor de la Cruz-Muñoz provides advanced evaluation and treatment for peptic ulcer disease, offering expertise in both medical and surgical management of complex foregut disorders.