Evaluation of Peptic Ulcer Disease
Peptic ulcers are defects in the gastric or duodenal mucosa through the muscularis mucosa. Unlike erosions or gastritis which are small or superficial lesions that involve only the mucosa, peptic ulcers can vary from as small as 5 mm to several centimeters, and the depth of injury may lead to life-threatening complications such as GI bleeding, perforation, or gastric outlet obstruction. Traditionally, peptic ulcer disease was thought to be secondary to acid hypersecretion. However, recent evidence suggests that the pathogenesis of peptic ulcers is multifactorial and due to an imbalance of inciting factors and protective factors. A robust literature has shown that eradication of H. pylori can reduce the rate of ulcer recurrence. Additionally, the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and aspirin have also been closely linked to the formation of peptic ulcers due to the inhibition of cyclooxygenase-1 (COX-1) which results in impaired mucosal healing. Evaluation of peptic ulcer disease now largely rests on the diagnosis of these two predisposing factors of H. pylori infection and impaired mucosal healing from NSAID use.
KeywordsPeptic ulcer disease Peptic ulcers H. pylori Nonsteroidal anti-inflammatory drugs NSAID
- 28.Greenberger NJ, Blumber RS, Burakoff R. Current diagnosis and treatment: gastroenterology, hepatology, & endoscopy. 3rd ed. New York: McGraw-Hill Education; 2016.Google Scholar