Peptic Ulcer Disease
BASICS
Defects in the stomach and/or duodenal mucosa leads to inflammation and erosion of the underlying tissue by gastric acid and pepsin.
DESCRIPTION
- Mucosal breaks extending into the submucosa or muscularis propria >3 to 5 mm located in the stomach or duodenum
- Peptic ulcer disease (PUD) is an endoscopic diagnosis versus dyspepsia that is a clinical diagnosis.
- Helicobacter pylori and aspirin/NSAIDs use are the leading causes of ulcers.
- NSAIDs use plus H. pylori infection increases the risk of PUD by 60-fold.
- Multiple ulcers/ulcers distal to the second portion of duodenum and/or jejunum raise possibility of gastrinoma (Zollinger-Ellison syndrome [ZES]).
- Idiopathic ulcers now account for 20% of PUD (1).
EPIDEMIOLOGY
Incidence
United States: incidence ~500,000 cases/year (2)
Prevalence
- Highest prevalence in South Asia
- Low and middle income countries have a higher prevalence of H. pylori infections and PUD (1).
RISK FACTORS
- H. pylori infection
- Long term NSAIDs use
- Other medications: corticosteroids, bisphosphonates, potassium chloride, clopidogrel, sirolimus, chemotherapeutic agents, SSRIs
- Hypersecretion syndromes: gastrinoma (ZES), systemic mastocytosis, cystic fibrosis, hyperparathyroidism, carcinoid syndrome, antral G-cell hyperplasia
- Tobacco, alcohol, stress, radiation therapy, obesity
GENERAL PREVENTION
- Limit NSAIDs, aspirin, alcohol, tobacco, caffeine
- If NSAIDs are necessary, use the lowest possible dose with a proton pump inhibitor (PPI) or misoprostol. Test for and eradicate H. pylori.
- Treat with PPIs or H2 blockers for patients at risk of complications and recurrence.
- Strong association between obesity and PUD; counsel patients on weight loss.
COMMONLY ASSOCIATED CONDITIONS
Gastrinoma (ZES); multiple endocrine neoplasia type 1 (MEN 1); carcinoid syndrome
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Citation
Domino, Frank J., et al., editors. "Peptic Ulcer Disease." 5-Minute Clinical Consult, 34th ed., Wolters Kluwer, 2026. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688510/all/Peptic_Ulcer_Disease.
Peptic Ulcer Disease. In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2026. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688510/all/Peptic_Ulcer_Disease. Accessed July 16, 2025.
Peptic Ulcer Disease. (2026). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (34th ed.). Wolters Kluwer. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688510/all/Peptic_Ulcer_Disease
Peptic Ulcer Disease [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2026. [cited 2025 July 16]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688510/all/Peptic_Ulcer_Disease.
* Article titles in AMA citation format should be in sentence-case
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