Peptic Ulcer (Gastric & Duodenal)

A peptic ulcer results from an imbalance between the factors that attack and those that protect the lining (mucosa).

The two main causes are Helicobacter pylori and NSAIDs (including aspirin). Helicobacter pylori is found in 70% of gastric ulcers and in more than 90% of duodenal ulcers, compared with 30% of the general population. Other, much less common causes are smoking and stress (for example, patients in intensive care).

Typical ulcer pain is felt in the upper middle abdomen (epigastrium), some time after meals, without spreading, like a cramp or painful hunger, and is relieved by eating or taking antacids. It can be atypical, like a burning sensation or a cramp unrelated to meals.

Upper GI endoscopy (gastroscopy) is the reference examination. It is required for any typical ulcer pain, for atypical pain with warning signs (bleeding, anemia, weight loss, loss of appetite), and for pain that does not respond to treatment or is associated with Helicobacter pylori.

Treatment is based on:

• Eradicating Helicobacter pylori (several lines of treatment combining antibiotics and double-dose PPIs)
• Continuing PPIs (proton pump inhibitors) for 4 to 6 weeks

A follow-up gastroscopy should always be planned, for gastric ulcers only.

Complications include bleeding, perforation, pyloroduodenal stenosis and malignant transformation (which concerns chronic gastric ulcers and is in fact more related to the underlying chronic gastritis than to true cancerous change of the ulcer).