Peptic ulcer disease

Peptic ulcer disease is a break in the inner lining of the stomach, the first part of the small intestine, or sometimes the lower esophagus.^[1][7] An ulcer in the stomach is called a gastric ulcer, while one in the first part of the intestines is a duodenal ulcer.^[1] The most common symptoms of a duodenal ulcer are waking at night with upper abdominal pain, and upper abdominal pain that improves with eating.^[1] With a gastric ulcer, the pain may worsen with eating.^[8] The pain is often described as a burning or dull ache.^[1] Other symptoms include belching, vomiting, weight loss, or poor appetite.^[1] About a third of older people with peptic ulcers have no symptoms.^[1] Complications may include bleeding, perforation, and blockage of the stomach.^[2] Bleeding occurs in as many as 15% of cases.^[2]

Common causes include infection with Helicobacter pylori and non-steroidal anti-inflammatory drugs (NSAIDs).^[1] Other, less common causes include tobacco smoking, stress as a result of other serious health conditions, Behçet's disease, Zollinger–Ellison syndrome, Crohn's disease, and liver cirrhosis.^[1][3] Older people are more sensitive to the ulcer-causing effects of NSAIDs.^[1] The diagnosis is typically suspected due to the presenting symptoms with confirmation by either endoscopy or barium swallow.^[1] H. pylori can be diagnosed by testing the blood for antibodies, a urea breath test, testing the stool for signs of the bacteria, or a biopsy of the stomach.^[1] Other conditions that produce similar symptoms include stomach cancer, coronary heart disease, and inflammation of the stomach lining or gallbladder inflammation.^[1]

Diet does not play an important role in either causing or preventing ulcers.^[9] Treatment includes stopping smoking, stopping use of NSAIDs, stopping alcohol, and taking medications to decrease stomach acid.^[1] The medication used to decrease acid is usually either a proton pump inhibitor (PPI) or an H2 blocker, with four weeks of treatment initially recommended.^[1] Ulcers due to H. pylori are treated with a combination of medications, such as amoxicillin, clarithromycin, and a PPI.^[4] Antibiotic resistance is increasing and thus treatment may not always be effective.^[4] Bleeding ulcers may be treated by endoscopy, with open surgery typically only used in cases in which it is not successful.^[2]

Peptic ulcers are present in around 4% of the population.^[1] New ulcers were found in around 87.4 million people worldwide during 2015.^[5] About 10% of people develop a peptic ulcer at some point in their life.^[10] Peptic ulcers resulted in 267,500 deaths in 2015, down from 327,000 in 1990.^[6][11] The first description of a perforated peptic ulcer was in 1670, in Princess Henrietta of England.^[2] H. pylori was first identified as causing peptic ulcers by Barry Marshall and Robin Warren in the late 20th century,^[4] a discovery for which they received the Nobel Prize in 2005.^[12]