Peptic ulcer

Benign gastric and duodenal ulcers are best classified together as peptic ulcers even though their aetiology is different.

In both types of ulcer it is acid pepsin which causes the mucosal damage. Duodenal ulcers are the more common.

Endoscopic examination and microbiological sampling of the upper gastrointestinal tract often reveals the presence of Helicobacter pylori (formerly known as Campylobacter pylori).

Ulceration involves penetration of the muscularis mucosae and so, differs from an erosion, in which only the mucosal surface is disrupted. Lesions vary from one millimetre to several centimetres in diameter.

Summary causes of peptic ulcer disease (2)

• Helicobacter pylori infection causes about 42% of peptic ulcers, although only 10% of people with H pylori develop a peptic ulcer
• about 36% of peptic ulcers are associated with use of a nonsteroidal anti-inflammatory drug (NSAID) such as aspirin or ketorolac
• other risk factors include:
  • cigarette smoking,
  • psychological stress,
  • family history of peptic ulcer disease,
  • adverse childhood circumstances such as crowded living conditions and poor water quality can increase the risk of development of peptic ulcer disease

Reference

1. National Institute for Health and Care Excellence. Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management. September 2019 [internet publication].
2. Vakil N. Peptic ulcer disease: a review. JAMA. 2024;332(21):1832-1842.