Gastroenterology & Nutrition

Peptic Ulcer Disease

A gastric or duodenal mucosal breach occurs when H. pylori, NSAIDs or another insult overwhelms mucosal defence; the high-yield priorities are cause-directed treatment and early recognition of bleeding, perforation, obstruction and gastric malignancy.

Definition

Peptic ulcer disease is a mucosal break in the stomach or duodenum extending through the muscularis mucosae, most often related to H. pylori infection or NSAID exposure.

First principles

Ulceration is usually loss of defence rather than simply excess acid

Mucus, bicarbonate, mucosal blood flow and prostaglandin-dependent repair normally protect the gastroduodenal lining. H. pylori causes chronic gastric inflammation and impairs this barrier, while NSAIDs reduce protective prostaglandin synthesis. Acid suppression helps healing, but durable treatment depends on addressing the cause.

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