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Peptic Ulcer Disease

Peptic Ulcer Disease is a topic covered in the Washington Manual of Medical Therapeutics.

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General Principles

Definition

PUD consists of mucosal breaks in the stomach and duodenum when corrosive effects of acid and pepsin overwhelm mucosal defense mechanisms. Other locations include esophagus, small bowel adjacent to gastroenteric anastomoses, and within a Meckel diverticulum.

Etiology

  • Helicobacter pylori, a spiral, gram-negative, urease-producing bacillus, is responsible for at least half of all PUD and the majority of ulcers that are not due to NSAIDs.
  • PUD can develop in 15–25% of chronic NSAID and aspirin users. Past history of PUD, age >60 years, concomitant corticosteroid or anticoagulant therapy, high-dose or multiple NSAID therapy, and presence of serious comorbid medical illnesses increase risk for PUD (J Clin Gastroenterol 1997;24:2  [PMID:9013343]).
  • A gastrin-secreting tumor or gastrinoma accounts for <1% of all peptic ulcers.
  • Gastric cancer or lymphoma may manifest as a gastric ulcer.
  • When none of these etiologies are evident, PUD is designated idiopathic. Most idiopathic PUD could be due to undiagnosed H. pylori or undetected NSAID use.
  • Cigarette smoking doubles the risk for PUD; it delays healing and promotes recurrence.

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Citation

Williams, Dominique, et al., editors. "Peptic Ulcer Disease." Washington Manual of Medical Therapeutics, 35th ed., Wolters Kluwer Health, 2016. Washington Manual, www.unboundmedicine.com/washingtonmanual/view/Washington-Manual-of-Medical-Therapeutics/602534/6/Peptic_Ulcer_Disease.
Peptic Ulcer Disease. In: Williams D, Ramgopal R, Gdowski M, et al, eds. Washington Manual of Medical Therapeutics. 35th ed. Wolters Kluwer Health; 2016. https://www.unboundmedicine.com/washingtonmanual/view/Washington-Manual-of-Medical-Therapeutics/602534/6/Peptic_Ulcer_Disease. Accessed June 25, 2019.
Peptic Ulcer Disease. (2016). In Williams, D., Ramgopal, R., Gdowski, M., Dretler, A., & Bhat, P. (Eds.), Washington Manual of Medical Therapeutics. Available from https://www.unboundmedicine.com/washingtonmanual/view/Washington-Manual-of-Medical-Therapeutics/602534/6/Peptic_Ulcer_Disease
Peptic Ulcer Disease [Internet]. In: Williams D, Ramgopal R, Gdowski M, Dretler A, Bhat P, editors. Washington Manual of Medical Therapeutics. Wolters Kluwer Health; 2016. [cited 2019 June 25]. Available from: https://www.unboundmedicine.com/washingtonmanual/view/Washington-Manual-of-Medical-Therapeutics/602534/6/Peptic_Ulcer_Disease.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Peptic Ulcer Disease ID - 602534 ED - Williams,Dominique, ED - Ramgopal,Rajeev, ED - Gdowski,Mark, ED - Dretler,Alexandra, ED - Bhat,Pavat, BT - Washington Manual of Medical Therapeutics UR - https://www.unboundmedicine.com/washingtonmanual/view/Washington-Manual-of-Medical-Therapeutics/602534/6/Peptic_Ulcer_Disease PB - Wolters Kluwer Health ET - 35 DB - Washington Manual DP - Unbound Medicine ER -