Skip to main content
SpringerLink
Log in

Evaluation of Peptic Ulcer Disease

  • Chapter
  • First Online:
The SAGES Manual of Foregut Surgery

Abstract

Peptic ulcers are defects in the gastric or duodenal mucosa through the muscularis mucosa. Unlike erosions or gastritis which are small or superficial lesions that involve only the mucosa, peptic ulcers can vary from as small as 5 mm to several centimeters, and the depth of injury may lead to life-threatening complications such as GI bleeding, perforation, or gastric outlet obstruction. Traditionally, peptic ulcer disease was thought to be secondary to acid hypersecretion. However, recent evidence suggests that the pathogenesis of peptic ulcers is multifactorial and due to an imbalance of inciting factors and protective factors. A robust literature has shown that eradication of H. pylori can reduce the rate of ulcer recurrence. Additionally, the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and aspirin have also been closely linked to the formation of peptic ulcers due to the inhibition of cyclooxygenase-1 (COX-1) which results in impaired mucosal healing. Evaluation of peptic ulcer disease now largely rests on the diagnosis of these two predisposing factors of H. pylori infection and impaired mucosal healing from NSAID use.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 149.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 199.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Lanas A, Chan FK. Peptic ulcer disease. Lancet. 2017;390(10094):613–24.

    Article  Google Scholar 

  2. Sandler RS, Everhart JE, Donowitz M, et al. The burden of selected digestive diseases in the United States. Gastroenterology. 2002;122:1500–11.

    Article  Google Scholar 

  3. Sung JJ, Kuipers EJ, El-Serag HB. Systematic review: the global incidence and prevalence of peptic ulcer disease. Aliment Pharmacol Ther. 2009;29:938–46.

    Article  CAS  Google Scholar 

  4. Wang YR, Richter JE, Dempsey DT. Trends and outcomes of hospitalizations for peptic ulcer disease in the United States, 1993 to 2006. Ann Surg. 2010;251:51–8.

    Article  Google Scholar 

  5. Kuipers EJ, Thijs JC, Festen HP. The prevalence of Helicobacter pylori in peptic ulcer disease. Aliment Pharmacol Ther. 1995;9(Suppl 2):59–69.

    PubMed  Google Scholar 

  6. Sipponen P, Varis K, Fraki O, Korri UM, Seppala K, Siurala M. Cumulative 10-year risk of symptomatic duodenal and gastric ulcer in patients with or without chronic gastritis. A clinical follow-up study of 454 outpatients. Scand J Gastroenterol. 1990;25:966–73.

    Article  CAS  Google Scholar 

  7. Charpignon C, Lesgourgues B, Pariente A, et al. Peptic ulcer disease: one in five is related to neither Helicobacter pylori nor aspirin/NSAID intake. Aliment Pharmacol Ther. 2013;38:946–54.

    Article  CAS  Google Scholar 

  8. Crooks CJ, West J, Card TR. Comorbidities affect risk of nonvariceal upper gastrointestinal bleeding. Gastroenterology. 2013;144:1384–93. 93 e1–2; quiz e18–9.

    Article  Google Scholar 

  9. Cover TL, Blaser MJ. Helicobacter pylori in health and disease. Gastroenterology. 2009;136:1863–73.

    Article  CAS  Google Scholar 

  10. Yamaoka Y. Mechanisms of disease: Helicobacter pylori virulence factors. Nat Rev Gastroenterol Hepatol. 2010;7:629–41.

    Article  CAS  Google Scholar 

  11. Gisbert JP, Abraira V. Accuracy of Helicobacter pylori diagnostic tests in patients with bleeding peptic ulcer: a systematic review and meta-analysis. Am J Gastroenterol. 2006;101:848–63.

    Article  Google Scholar 

  12. Lanas A, Carrera-Lasfuentes P, Arguedas Y, et al. Risk of upper and lower gastrointestinal bleeding in patients taking nonsteroidal anti-inflammatory drugs, antiplatelet agents, or anticoagulants. Clin Gastroenterol Hepatol. 2015;13:906–12. e2.

    Article  Google Scholar 

  13. Lanas A, Garcia-Rodriguez LA, Arroyo MT, et al. Risk of upper gastrointestinal ulcer bleeding associated with selective cyclo-oxygenase-2 inhibitors, traditional non-aspirin non-steroidal anti-inflammatory drugs, aspirin and combinations. Gut. 2006;55:1731–8.

    Article  CAS  Google Scholar 

  14. Huang JQ, Sridhar S, Hunt RH. Role of Helicobacter pylori infection and non-steroidal anti-inflammatory drugs in peptic-ulcer disease: a meta-analysis. Lancet. 2002;359:14–22.

    Article  CAS  Google Scholar 

  15. Chan FK, To KF, Wu JC, et al. Eradication of Helicobacter pylori and risk of peptic ulcers in patients starting long-term treatment with non-steroidal anti-inflammatory drugs: a randomised trial. Lancet. 2002;359:9–13.

    Article  CAS  Google Scholar 

  16. Labenz J, Blum AL, Bolten WW, et al. Primary prevention of diclofenac associated ulcers and dyspepsia by omeprazole or triple therapy in Helicobacter pylori positive patients: a randomised, double blind, placebo controlled, clinical trial. Gut. 2002;51:329–35.

    Article  CAS  Google Scholar 

  17. Chan FK, Wong VW, Suen BY, et al. Combination of a cyclo-oxygenase-2 inhibitor and a proton-pump inhibitor for prevention of recurrent ulcer bleeding in patients at very high risk: a double-blind, randomised trial. Lancet. 2007;369:1621–6.

    Article  CAS  Google Scholar 

  18. Johnson HD. Gastric ulcer: classification, blood group characteristics, secretion patterns and pathogenesis. Ann Surg. 1965;162:996–1004.

    Article  CAS  Google Scholar 

  19. Scott JW, Olufajo OA, Brat GA, et al. Use of national burden to define operative emergency general surgery. JAMA Surg. 2016;151:e160480.

    Article  Google Scholar 

  20. Sarosi GA Jr, Jaiswal KR, Nwariaku FE, Asolati M, Fleming JB, Anthony T. Surgical therapy of peptic ulcers in the 21st century: more common than you think. Am J Surg. 2005;190:775–9.

    Article  Google Scholar 

  21. Agreus L, Talley NJ, Jones M. Value of the “Test & Treat” strategy for uninvestigated dyspepsia at low prevalence rates of Helicobacter pylori in the population. Helicobacter. 2016;21:186–91.

    Article  CAS  Google Scholar 

  22. Delaney BC, Qume M, Moayyedi P, et al. Helicobacter pylori test and treat versus proton pump inhibitor in initial management of dyspepsia in primary care: multicentre randomised controlled trial (MRC-CUBE trial). BMJ. 2008;336:651–4.

    Article  CAS  Google Scholar 

  23. Gisbert JP, Esteban C, Jimenez I, Moreno-Otero R. 13C-urea breath test during hospitalization for the diagnosis of Helicobacter pylori infection in peptic ulcer bleeding. Helicobacter. 2007;12:231–7.

    Article  CAS  Google Scholar 

  24. Lin HJ, Lo WC, Perng CL, et al. Helicobacter pylori stool antigen test in patients with bleeding peptic ulcers. Helicobacter. 2004;9:663–8.

    Article  Google Scholar 

  25. Laine L. Upper gastrointestinal bleeding due to a peptic ulcer. N Engl J Med. 2016;375:1198.

    Article  Google Scholar 

  26. Dooley CP, Larson AW, Stace NH, et al. Double-contrast barium meal and upper gastrointestinal endoscopy. A comparative study. Ann Intern Med. 1984;101:538–45.

    Article  CAS  Google Scholar 

  27. Glick SN. Duodenal ulcer. Radiol Clin N Am. 1994;32:1259–74.

    CAS  PubMed  Google Scholar 

  28. Greenberger NJ, Blumber RS, Burakoff R. Current diagnosis and treatment: gastroenterology, hepatology, & endoscopy. 3rd ed. New York: McGraw-Hill Education; 2016.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Thomas C. Tsai

  2. Division of General and Gastrointestinal Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    David C. Brooks

Authors
  1. Thomas C. Tsai
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. David C. Brooks
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to David C. Brooks .

Editor information

Editors and Affiliations

  1. University of Alabama at Birmingham , Birmingham, AL, USA

    Jayleen Grams

  2. The Ohio State University, Columbus, OH, USA

    Kyle A. Perry

  3. Brigham and Women’s Hospital, Boston, MA, USA

    Ali Tavakkoli

Rights and permissions

Reprints and permissions

Copyright information

© 2019 SAGES

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Tsai, T.C., Brooks, D.C. (2019). Evaluation of Peptic Ulcer Disease. In: Grams, J., Perry, K., Tavakkoli, A. (eds) The SAGES Manual of Foregut Surgery . Springer, Cham. https://doi.org/10.1007/978-3-319-96122-4_53

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-96122-4_53

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-96121-7

  • Online ISBN: 978-3-319-96122-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation