Peptic ulcer

Peptic ulcer disease (PUD) key points

• Peptic ulcers are common: effect 10% of the population
• Peptic ulcers refer to ulceration of the stomach and duodenum
• Peptic ulcer defined as erosion >5mm diameter
• Ulcers occur when the balance between digestive enzymes and mucosal defences is lost.

• H.pylori (70-80% of gastric ulcers and >90% of duodenal ulcers are H.pylori related)
• NSAIDs other main cause
• Other causes are: smoking, alcohol, drugs e.g. steroids, stress e.g. burns, autoimmune causes e.g. Crohns, tumours e.g. Zollinger-Ellison syndrome and gastric cancer

• Bleeding: peptic ulcer disease most common cause upper GI bleed.
• Perforation: 20% of patients with PUD will perforate

• Most common site of perforation is anterior wall of the 1st part of duodenum
• Most common site of significant bleeding is posterior wall of the 1st part of duodenum where ulcer erodes gastroduodenal artery