Peptic Ulcer Disease

People in Western populations have a 1 in 10 lifetime risk of developing peptic ulcer disease. Although recent decades have seen major advances in our knowledge and treatment of peptic ulcers, symptoms and complications from peptic ulcers remain a significant problem for primary and secondary care practitioners. Primary care practitioners have a central role in the prevention, recognition and treatment of peptic ulcers. This article summarizes the causes, presentations, investigation and current treatment of peptic ulcer disease.

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The Role of Gastric Acid in Preventing Foodborne Disease and How Bacteria Overcome Acid Conditions†

Journal of Food Protection ◽

10.4315/0362-028x-66.7.1292 ◽

2003 ◽

Vol 66 (7) ◽

pp. 1292-1303 ◽

Cited By ~ 126

Author(s):

JAMES L. SMITH

Keyword(s):

Peptic Ulcer ◽

Acid Secretion ◽

Peptic Ulcer Disease ◽

Gastric Acid Secretion ◽

Gastric Acid ◽

Gastric Fluid ◽

The Body ◽

Peptic Ulcers ◽

Ulcer Disease ◽

H Pylori

The secretion of hydrochloric acid by the stomach plays an important role in protecting the body against pathogens ingested with food or water. A gastric fluid pH of 1 to 2 is deleterious to many microbial pathogens; however, the neutralization of gastric acid by antacids or the inhibition of acid secretion by various drugs may increase the risk of food- or waterborne illnesses. Peptic ulcer disease is often treated by decreasing or eliminating gastric acid secretion, and such treatment blocks the protective antibacterial action of gastric fluid. The majority of peptic ulcer disease cases originate from Helicobacter pylori infections. Treatment of H. pylori–induced peptic ulcers with antibiotics reduces the need for drugs that inhibit gastric acid secretion and thereby diminishes the risk of food- and waterborne illness for peptic ulcer disease patients. Many bacterial pathogens, such as Escherichia coli, Salmonella Typhimurium, and H. pylori, can circumvent the acid conditions of the stomach by developing adaptive mechanisms that allow these bacteria to survive in acid environments. As a consequence, these bacteria can survive acidic stomach conditions and pass into the intestinal tract, where they can induce gastroenteritis.

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Helicobacter pylori test-and-treat intervention compared to usual care in primary care patients with suspected peptic ulcer disease in the United States

The American Journal of Gastroenterology ◽

10.1111/j.1572-0241.2002.07118.x ◽

2002 ◽

Vol 97 (12) ◽

pp. 3007-3014 ◽

Cited By ~ 21

Author(s):

Uri Ladabaum ◽

A. Mark Fendrick ◽

David Glidden ◽

James M. Scheiman

Keyword(s):

United States ◽

Primary Care ◽

Helicobacter Pylori ◽

Peptic Ulcer ◽

Peptic Ulcer Disease ◽

Usual Care ◽

The United States ◽

Ulcer Disease ◽

Test And Treat ◽

Primary Care Patients

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P-BN10 Seasonal Variation of Presentation of Perforated Peptic Ulcer Disease: An Overview of Patient Demographics, Management and Outcomes in Northern Ireland

British Journal of Surgery ◽

10.1093/bjs/znab430.011 ◽

2021 ◽

Vol 108 (Supplement_9) ◽

Author(s):

Bakhat Yawar ◽

Ahmed Marzouk ◽

Heba Ali ◽

Alsarah Diab ◽

Hassan Abdulrahman ◽

...

Keyword(s):

Peptic Ulcer ◽

Seasonal Variation ◽

Peptic Ulcer Disease ◽

Perforated Peptic Ulcer ◽

Peptic Ulcers ◽

Northern Irish ◽

Mortality And Morbidity ◽

Ulcer Disease ◽

Patient Demographics ◽

Acute Peritonitis

Abstract Background Perforated peptic ulcer disease is one of the most common causes of acute peritonitis. It carries significant mortality and morbidity. Several previous studies have reported a seasonal variation in presentation of patients with perforated ulcers. Here we present this study from a Northern Irish perspective on perforated peptic ulcers. Methods A retrospective cohort study was conducted on perforated peptic ulcer patients who presented to Altnagelvin Area Hospital emergency department between 2015 to 2020. Data on patient demographics, clinical presentation, investigations, management and outcomes were collected. Primary outcome was to investigate if seasonality was associated with incidence of perforated peptic ulcers. Follow-up data was also collected. Seasons were defined as per UK Met Office. Results Results: A total of 50 patients presented with perforated PUD. Male:female ratio was approximately 3:2. Peaks were noted in spring and winter. April was the most common month for presentation followed by December. Smoking was the most common risk factor followed by alcohol abuse. 14 patients (28%) were either very frail or had contained perforations and were conservatively managed. 3 deaths were noted (6%). 13 patients (26%) required ICU admission at some stage in their management. Conclusions Slight seasonal variation was noted in presentation of perforated peptic ulcers in our study with more common incidence in winter and spring months. The month of April was noted to have the peak incidence of the disease in our study.

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Hemostatic spray powder TC-325 in the primary endoscopic treatment of peptic ulcer-related bleeding: multicenter international registry

Endoscopy ◽

10.1055/a-1186-5360 ◽

2020 ◽

Vol 53 (01) ◽

pp. 36-43

Author(s):

Mohamed Hussein ◽

Durayd Alzoubaidi ◽

Miguel-Fraile Lopez ◽

Michael Weaver ◽

Jacobo Ortiz-Fernandez-Sordo ◽

...

Keyword(s):

Peptic Ulcer ◽

Peptic Ulcer Disease ◽

Rescue Therapy ◽

Case Series ◽

Ulcer Bleeding ◽

Peptic Ulcers ◽

Gi Bleeding ◽

Ulcer Disease ◽

Bleeding Peptic Ulcers ◽

The Uk

Abstract Background Upper gastrointestinal bleeding (UGIB) is a leading cause of morbidity and is associated with a 2 % – 17 % mortality rate in the UK and USA. Bleeding peptic ulcers account for 50 % of UGIB cases. Endoscopic intervention in a timely manner can improve outcomes. Hemostatic spray is an endoscopic hemostatic powder for GI bleeding. This multicenter registry was created to collect data prospectively on the immediate endoscopic hemostasis of GI bleeding in patients with peptic ulcer disease when hemostatic spray is applied as endoscopic monotherapy, dual therapy, or rescue therapy. Methods Data were collected prospectively (January 2016 – March 2019) from 14 centers in the UK, France, Germany, and the USA. The application of hemostatic spray was decided upon at the endoscopist’s discretion. Results 202 patients with UGIB secondary to peptic ulcers were recruited. Immediate hemostasis was achieved in 178/202 patients (88 %), 26/154 (17 %) experienced rebleeding, 21/175 (12 %) died within 7 days, and 38/175 (22 %) died within 30 days (all-cause mortality). Combination therapy of hemostatic spray with other endoscopic modalities had an associated lower 30-day mortality (16 %, P < 0.05) compared with monotherapy or rescue therapy. There were high immediate hemostasis rates across all peptic ulcer disease Forrest classifications. Conclusions This is the largest case series of outcomes of peptic ulcer bleeding treated with hemostatic spray, with high immediate hemostasis rates for bleeding peptic ulcers.

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Screening and Preponderance of Peptic ulcer and its Contributing risk factors Among Basrah City Residents in Iraq

Current Drug Safety ◽

10.2174/1574886315666201013151640 ◽

2020 ◽

Vol 15 ◽

Author(s):

Ausama Jaccob ◽

Sheima Kadhim ◽

Amal Hassan ◽

Ali Mohsin ◽

Salah Muslim

Keyword(s):

Peptic Ulcer ◽

Peptic Ulcer Disease ◽

Teaching Hospital ◽

Antiplatelet Agents ◽

Peptic Ulcers ◽

Medication History ◽

Ulcer Disease ◽

Chronic Medication ◽

Number Of Patients ◽

H Pylori

Background: With the recent widespread use of over- the- counter drugs, there has been a noticeable increase in the occurrence of gastrointestinal discomfort and peptic ulcer disease. However, peptic ulcer is a highly complex disorder resulting from an imbalance between gstricdestructive and protective factors. Objectives: To identifyrisk factors of peptic ulcer disease. Methods: This study was organized at Al-Basra teaching hospital and Al Sader teaching hospital in Basrah city, Iraq. Medical records and questionnaires filled by patients undergoing diagnostic and therapeutic upper gastrointestinal endoscopies following their gastric discomfort complaints. Information related to patients, disease history and medication history during six months prior to endoscopy procedures was collected. Results: A total of 476 patients were identified, including 246 (51.7%) patients with endoscopically diagnosed peptic ulcers and 230 (48.3%) patients without peptic ulcers. The population was predominately male and there were significant differences between age groups.Smoking correlated with a high relative risk;however, alcohol drinking had no significant role as a causative factor. The most extensively used drugs by patients who complained of peptic ulcers are NSAIDs, iron supplements, corticosteroids, and antiplatelet agents. A small number of patients weretreated for hypertension and diabetes, which were correlated with peptic ulcer risks. The presence of H-pylori infections was significantly associated with peptic ulcer diagnosis. Conclusion: The risk of peptic ulcer disease appeared to increase with chronic medication use and smoking, which aggravatethe contributing risk by H-pylori infections.

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Diseases of the Stomach

10.2310/fm.4114 ◽

2016 ◽

Author(s):

Tara C. Sheets ◽

Moath Amro

Keyword(s):

Peptic Ulcer ◽

Peptic Ulcer Disease ◽

Early Recognition ◽

Esophageal Disease ◽

Peptic Ulcers ◽

Button Battery ◽

Ulcer Disease ◽

Common Causes ◽

Major Emergencies ◽

H Pylori

There are multiple diseases of the stomach and esophagus that will lead a patient to seek emergent care, including peptic ulcer disease (PUD), esophagitis, dysphagia, esophageal foreign bodies, and gastroesophageal reflux disease (GERD). Hemorrhage and perforation are major emergencies in peptic ulcer disease and esophageal disease requiring early recognition with immediate resuscitative efforts to stabilize. This review covers the risk factors, pathophysiology, assessment and stabilization, diagnosis and treatment, and disposition and outcomes for patients with diseases of the stomach and esophagus. Figures show illustrations of esophageal anatomy, an algorithm for the evaluation of dysphagia, the pathogenesis of peptic ulcers, and radiographs demonstrating an esophageal button battery and pneumoperitoneum caused by a perforated ulcer. Tables list some common causes of esophageal stricture and pill-induced esophagitis, differential diagnosis of peptic ulcer disease and commonly used regimens to eradicate Helicobacter pylori infection. Key Words: Peptic ulcer disease, esophagitis, dysphagia, esophageal foreign body, GERD, H. Pylori, button battery

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Abstract 385: The Impact of Aspirin Primary Prevention Treatment Guidelines: Temporal Trends in Aspirin Use for Primary vs Secondary Prevention, 2005-2013

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.7.suppl_1.385 ◽

2014 ◽

Vol 7 (suppl_1) ◽

Author(s):

Jeremy R Van't Hof ◽

Niki Oldenburg ◽

Sue Duval ◽

Serban Dronca ◽

Andrew Olson ◽

...

Keyword(s):

Primary Care ◽

Peptic Ulcer ◽

Primary Prevention ◽

Secondary Prevention ◽

Health System ◽

Peptic Ulcer Disease ◽

Ulcer Disease ◽

Primary Care Clinics ◽

History Of ◽

Artery Disease

Background: Current national prevention guidelines recommend use of low dose aspirin (ASA) for both the primary prevention (PP) and secondary prevention (SP) of heart attack and stroke. ASA use for SP has been documented to have increased over the past decade. Since the publication of the 2009 United States Preventative Services Task Force (USPSTF) recommendations for PP ASA use, data describing the trends in PP ASA use in primary care are sparse. This study evaluates trends in PP and SP ASA use in primary care clinics from a large, regional health system over an 8 year period (2005-2013). Methods: A bi-annual cross-sectional electronic medical record (EMR) chart extraction was performed from 2005 to 2013 to evaluate documented ASA use for all patient encounters within primary care clinics in the Fairview Health System (Minnesota). Primary prevention candidates were defined as individuals within the USPSTF guideline age and sex target populations (men aged 45-79, and women aged 55-79 years) with no documented history of an atherosclerotic syndrome or contraindication to ASA use (aspirin allergy, peptic ulcer disease, or concurrent antithrombotic therapy). Secondary prevention candidates were defined as adults within the same age and gender range with a history of coronary artery disease, peripheral artery disease or ischemic stroke. The ASA treatment to candidacy ratio was calculated for the PP and SP populations. Results: Over 225,000 unique encounters at 66 primary care clinics were analyzed over the 8 year study period. The PP population was younger (60.4±8.7 vs. 66.2±8.3 years), with lower prevalence of hypertension (49 vs. 79%), hyperlipidemia (54 vs. 84%), and diabetes (17 vs. 35%) compared to the SP cohort. The mean SP ASA use of 86% was high, concordant with national trends, and did not change over this period. In contrast, PP ASA average use was 44% with no increase after publication of the 2009 USPSTF guideline. Documented contraindications to ASA use were uncommon (ASA allergy, 2.1 and 2.8%; peptic ulcer disease, 3.2 and 7.2%; and use of other antithrombotic medications, 4.6 and 32.6% in PP and SP populations respectively). Conclusion: Secondary prevention ASA use in primary care settings remains high, but ASA use for primary prevention of cardiovascular events is low. Despite creation of national guidelines, aspirin use in the PP population is half the rate of ASA use for secondary prevention. Additional methods to safely and effectively disseminate this primary prevention aspirin use recommendation, targeting both the public and health care providers, are warranted.

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Peptic Ulcer Disease in Children: Etiology, Clinical Findings, and Clinical Course

PEDIATRICS ◽

10.1542/peds.82.3.410 ◽

1988 ◽

Vol 82 (3) ◽

pp. 410-414

Author(s):

Brendan Drumm ◽

J. Marc Rhoads ◽

David A. Stringer ◽

Phillip M. Sherman ◽

Lynda E. Ellis ◽

...

Keyword(s):

Peptic Ulcer ◽

Peptic Ulcer Disease ◽

Emergency Surgery ◽

Clinical Course ◽

Clinical Findings ◽

Gastric Ulcers ◽

Peptic Ulcers ◽

Duodenal Ulcers ◽

Ulcer Disease ◽

Initial Symptoms

The records of all children with peptic ulcer disease at the Hospital for Sick Children were retrospectively evaluated, excluding neonates, throughout a 5-year period. Only cases with a definite ulcer crater identified either at endoscopy or at surgery were included. There were 36 patients, 20 boys and 16 girls. Duodenal ulcers were more common than gastric ulcers (2.8:1). Ages ranged from 3 months to 17 years, with a mean age of 10 years. Patients were reviewed with respect to etiology of peptic ulcer disease, age when first examined, initial symptoms, and clinical course. Patients were divided into two groups, those with primary (n = 19) and those with secondary (n = 17) peptic ulcer disease. All peptic ulcers in patients younger than 10 years of age were secondary in nature. Secondary ulcers occurred generally in association with a severe underlying illness (11/17), and many ulcers necessitated emergency surgery because of perforation and/or severe hemorrhage (8/17). None of these patients had chronic or recurrent symptoms. In contrast, in children with primary peptic ulcer disease, initial symptoms were more benign. Most patients had abdominal pain and only one required emergency surgery. Children with primary duodenal ulcer disease had a high incidence of recurrent symptoms (67%), however, with surgery for intractable disease necessitated in 40%. Single-contrast barium meals were found to be unreliable in establishing a diagnosis of peptic ulcer disease, particularly cases of gastric ulcer disease.

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Update on Peptic Ulcers in the Pediatric Age

Ulcers ◽

10.1155/2012/896509 ◽

2012 ◽

Vol 2012 ◽

pp. 1-9 ◽

Cited By ~ 6

Author(s):

Graziella Guariso ◽

Marco Gasparetto

Keyword(s):

Helicobacter Pylori ◽

Peptic Ulcer ◽

Peptic Ulcer Disease ◽

Immunosuppressive Drugs ◽

Stressful Events ◽

Peptic Ulcers ◽

Pediatric Age ◽

Adequate Treatment ◽

Medline Search ◽

Ulcer Disease

Background. Peptic ulcer disease (PUD) in children is reported worldwide, although it is relatively rare as compared with adults. Helicobacter pylori (HP) infection is a common cause of PUD in the pediatric age. Other risk factors include the use of nonsteroidal anti-inflammatory agents (NSAIDs), steroids, immunosuppressive drugs, and stressful events. Aim. To critically review the evidence on epidemiology, diagnostic management, and available treatments for PUD in the pediatric age. Methods. A MEDLINE search was performed indicating keywords as “Peptic Ulcer Disease,” “Epidemiology,” “Pediatric,” “Helicobacter pylori,” “Gastric ulcer,” “Bulbar Ulcer,” and “Upper Gastrointestinal Bleeding.” A selection of clinical trials, systematic reviews, and meta-analyses within the time period 2002–2012 was performed. Results. PUD in children is reported worldwide with an estimated frequency of 8.1% in Europe and of 17.4% in the US. When the underlying cause of PUD is addressed, the prognosis is excellent. Standard triple therapy, bismuth-based quadruple therapy, and the sequential therapy represent the current recommended treatments for HP related ulcers. NSAIDs related ulcers are treated by stopping the causative medications and by administration of proton-pump inhibitors or antisecretory drugs. Conclusions. PUD still represents a major concern in the paediatric age. A careful differential diagnosis and an adequate treatment constitute an excellent prognosis.

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