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Chapter 16 - Peptic ulcer disease

from Section 5 - Gastroenterology

Published online by Cambridge University Press:  05 September 2013

By
Frederick Gandolfo  and
Michael A. Poles
Edited by
Michael F. Lubin ,
Thomas F. Dodson  and
Neil H. Winawer
Michael F. Lubin
Affiliation:
Emory University, Atlanta
Thomas F. Dodson
Affiliation:
Emory University, Atlanta
Neil H. Winawer
Affiliation:
Emory University, Atlanta
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Summary

Introduction

Peptic ulcer disease (PUD) refers to a defect in the gastrointestinal mucosa of the stomach or duodenum that penetrates through the muscularis mucosa. Most studies of PUD have defined an ulcer as requiring a minimum diameter of 5 mm, although this size criterion is arbitrary. Ulcers form when there is a mismatch in protective and damaging gastrointestinal factors, with the most common destructive factors being infection with the bacteria Helicobacter pylori and use of non-steroidal anti-inflammatory drugs (NSAIDs). Without treatment of the primary cause, PUD is typically a relapsing-remitting chronic condition. Symptoms are variable, are often non-specific, and may even be absent. The mainstay of diagnosis of PUD is upper endoscopy. Since PUD is an acid-related condition, treatment includes acid suppression as well as specific treatment aimed at any causative factors identified.

Epidemiology

The worldwide incidence of PUD is approximately 0.1–0.2% and appears to be decreasing [1]. Furthermore, hospitalization rates, need for surgery, and PUD-related mortality are also all decreasing [2,3]. These improvements are likely due to the decreased prevalence of H. pylori, use of increasingly potent acid suppression, and the increased therapeutic role of upper endoscopy. The prevalence of PUD in patients with H. pylori infection is 1–6% [4], and is 11% in patients taking low-dose aspirin [5]; in the absence of H. pylori infection or NSAID use PUD is uncommon [6].

Type
Chapter
Information
Medical Management of the Surgical Patient
A Textbook of Perioperative Medicine
 , pp. 191 - 195
Publisher: Cambridge University Press
Print publication year: 2013

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