Peptic Ulcer Disease

Peptic Ulcer Disease (PUD) refers to focal mucosal defects extending through the muscularis mucosae in areas exposed to pepsin and gastric acid, predominantly the gastric antrum (Gastric Ulcers) and the proximal duodenal bulb (Duodenal Ulcers).

• Epigastric gnawing, aching, or burning abdominal pain
• Duodenal Ulcer pain: Typically occurs 2 to 3 hours postprandially or at night (awakening patient at 1-2 AM); temporarily relieved by food or antacids
• Gastric Ulcer pain: Often worsened or precipitated by food intake, causing anorexia and weight loss
• Bloating, early satiety, belching, and nausea
• Asymptomatic presentation (silent ulcers), common in elderly patients on NSAIDs

Over 90% of peptic ulcers are caused by two primary etiologies: (1) Chronic gastric mucosal infection by Helicobacter pylori bacteria, which disrupts the protective mucus-bicarbonate barrier, and (2) Regular use of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs: Ibuprofen, Aspirin, Diclofenac, Naproxen), which inhibit COX-1-mediated mucosal prostaglandin synthesis.

Upper Gastrointestinal Endoscopy (Esophagogastroduodenoscopy / EGD) is the definitive diagnostic procedure of choice, enabling direct visualization, ulcer measurement, biopsy to exclude gastric adenocarcinoma, and testing for H. pylori (Rapid Urease Test / histology). Non-invasive H. pylori testing includes the Stool Antigen Test and Urea Breath Test (UBT).

Eradication of H. pylori and profound acid suppression:

• H. pylori Eradication: Quadruple therapy (PPI + Bismuth subsalicylate + Metronidazole + Tetracycline) or Triple therapy (PPI + Clarithromycin + Amoxicillin) for 14 days.
• Proton Pump Inhibitors (PPIs): Omeprazole (20-40 mg) or Pantoprazole (40 mg) daily for 4 to 8 weeks to promote complete mucosal healing.
• Discontinuation of NSAIDs: Stop offending NSAIDs; if anti-inflammatory therapy is unavoidable, switch to a selective COX-2 inhibitor (Celecoxib) co-prescribed with a daily PPI.