Peptic ulcer disease (PUD) is defined as a disruption of the integrity of the mucosa of the stomach and/or duodenum, leading to a local defect or excavation due to active inflammation. PUD mostly occurs in the setting of chronic inflammation. It is common and often silent, and in most cases it can be traced to one of two causes: Helicobacter pylori infection or the use of non-steroidal anti-inflammatory drugs (NSAIDs). The idea that organises the topic is a balance: the mucosa is exposed to acid and other aggressive factors, and it is protected by its own defences. An ulcer forms when the balance tips, so understanding it means knowing how the stomach protects itself, what breaks that protection, and how the resulting damage presents and is treated.
Where to start
A reader new to the topic can take the notes in sequence, beginning with gastric physiology. A reader who already knows the disease and wants the practical picture can go straight to the clinical presentation, diagnosis and treatment.
The healthy stomach
- Gastric Physiology — how the stomach stores, mixes and empties food, and how its glands and cells make acid.
- Gastric Mucosal Defense — the three-level barrier that keeps the mucosa intact.
What breaks the balance
- Pathophysiology and Risk Factors — the definition, burden and risk factors of gastric and duodenal ulcers, and their different acid profiles.
- H. pylori and PUD — the bacterium’s epidemiology and virulence factors, and how it injures the mucosa.
- NSAIDs and PUD — how these drugs weaken the barrier and who is most at risk.
- Stress-Related Mucosal Injury — the acute erosive injury of critical illness and its prophylaxis.
- Gastritis: Acute and Chronic — inflammation of the stomach lining, from acute infection to chronic atrophic change.
Recognising and treating the disease
- Clinical Presentation — symptoms, their poor predictive value, and the alarm features that prompt endoscopy.
- PUD Diagnosis — endoscopy, biopsy of a gastric ulcer, and the tests for H. pylori.
- PUD Treatment — acid suppression, eradication regimens, and the management of NSAID-associated ulcers.
- PUD Complications — bleeding, perforation, penetration, outlet obstruction and malignancy.