Peptic ulceration is a common condition consisting of a distinct break in the gastrointestinal mucosa, usually of the stomach or duodenum. Duodenal ulcers are rarely malignant but gastric ulcers are more commonly associated with malignancy.
The aetiology of peptic ulcer disease is probably multifactorial but the bacterium Helicobacter pylori plays an important role. Abnormalities of normal mucosal defence mechanisms, and, in the case of gastric ulcer, reflux of duodenal contents into the stomach or delayed gastric emptying may also be involved. Other factors include emotional stress, smoking, alcohol, and drugs such as NSAIDs or corticosteroids.
Peptic ulcer disease usually presents as dyspeptic pain, sometimes associated with nausea, vomiting, anorexia, heartburn, or bloating. Patients may develop complications such as bleeding, obstruction, or perforation.
Certain simple measures such as bed rest, dietary modification, and cessation of smoking, may accelerate ulcer healing, but these play an adjuvant role, and the basis of treatment is pharmacological. Treatment is aimed at eradicating H. pylori with antibacterials and neutralising or inhibiting acid activity with antisecretory drugs, and a number of guidelines are available.1-4 Surgical treatment is used in patients with acute complications such as perforation, haemorrhage, obstruction, or pyloric stenosis, or in patients with recurrent or intractable ulcer disease, or where there is suspicion of malignancy.
