Ulcer Disease and Helicobacter pylori

Abstract

Peptic ulcer disease (PUD) involves defects in the gastric or duodenal mucosa resulting from an imbalance of gastric acid production and mucosal protection. Once a major cause of hospitalization and upper gastrointestinal surgery, the treatment of PUD was transformed by the discovery of a causal association with Helicobacter pylori (H. pylori) in the 1990s. Other etiologic factors include the use of nonsteroidal anti-inflammatory drugs (NSAIDs), steroids, tobacco, cancer, physiologic stress from burns (Curling’s ulcer), head injury (Cushing’s ulcer), surgery, critical illness, and conditions associated with hypersecretion of gastrin. In the United States, hospitalizations for PUD declined by 30–40 % between 1993 and 2006. This decrease has been attributed to the availability of diagnostic and therapeutic endoscopy and to the improved efficacy of medical therapy. However, PUD remains a condition that may require surgical intervention. The indications for operation in PUD include bleeding, perforation, obstruction, intractability, and inability to exclude neoplasm.