Peptic Ulcer Disease

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

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General Principles


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.


  • 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.1
  • 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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