Peptic ulcer disease
Gastric and duodenal ulcers are subtypes of peptic ulcers. They are characterised by erosion of the epithelial layer of the gastric or duodenal mucosa, which causes upper abdominal pain. Less frequent symptoms include dyspepsia and nausea. Gastro-intestinal perforation and haemorrhage are serious (possibly life-threatening) complications of peptic ulcer disease.
Two very common causes of peptic ulcer disease, which can occur independently or together, are Helicobacter pylori (H. pylori) infection and use of non-steroidal anti-inflammatory drugs (NSAIDs).
Treatment for all patients with peptic ulcers includes a proton pump inhibitor (PPI: omeprazole, esomeprazole, lansoprazole, rabeprazole or pantoprazole). An H2-receptor antagonist (H2RA: cimetidine or famotidine) has antisecretory activity in patients with peptic ulcers as well, but PPIs result in faster control of disease symptoms and higher healing rates due to strong suppression of acid secretion.
If H. pylori infection is confirmed, a PPI is administered together with an antibiotic regimen to treat the infection. Eradication of H. pylori in patients with peptic ulcer disease results in higher healing rates and lower ulcer recurrence rates in patients with duodenal and gastric ulcers. The selection of antibiotic regimen depends on the patient's potential for antibiotic resistance (and any potential hypersensitivity). In patients without risk of resistance to macrolide antibiotics, triple therapy with clarithromycin, amoxicillin and a PPI is used. In penicillin-allergic patients, metronidazole can be used instead of amoxicillin. In patients with macrolide resistance, quadruple therapy with bismuth subsalicylate, metronidazole, tetracycline and a PPI can be used.
Patients with NSAID-induced ulcer can be treated with a PPI as maintenance therapy if the patient needs to remain on an NSAID or aspirin therapy.
In addition to the antisecretory agents, other drugs with antiulcer activity include antacids (e.g., aluminum hydroxide, calcium carbonate), sucralfate, bismuth, misoprostol, and potassium-competitive acid inhibitors (e.g., vonoprazan).
Rare complications of peptic ulcer disease include bleeding (at the site of the ulcer), gastric perforation, and gastric obstruction.
Further details of PPIs, H2-receptor antagonists and agents used to treat other forms of dyspepsia are included in the Antisecretory drugs topic within the Drugs/Gastrointestinal system module.
UpToDate: Peptic ulcer disease: Epidemiology, etiology, and pathogenesis
UpToDate: Peptic ulcer disease: Treatment and secondary prevention
This webpage from the Wolters Kluwer UpToDate series summarises the treatments that are appropriate for peptic ulcer disease. It also addresses secondary prevention. The page was last updated in August 2022.
This webpage from the Wolters Kluwer UpToDate series summarises the epidemiology, etiology, and pathogenesis of peptic ulcer disease. It was last updated in July 2022.