From the Guidelines
Peptic ulcer disease is primarily caused by Helicobacter pylori infection and nonsteroidal anti-inflammatory drug (NSAID) use, as supported by the most recent and highest quality study 1.
Causes of Peptic Ulcer Disease
The causes of peptic ulcer disease can be broken down into several key factors, including:
- Helicobacter pylori infection, which infects the stomach lining, weakening its protective mucus layer and producing enzymes that damage tissue 1
- Nonsteroidal anti-inflammatory drug (NSAID) use, such as aspirin, ibuprofen, and naproxen, which inhibit prostaglandins that normally protect the stomach lining, reducing mucus production and increasing acid secretion 1
- Other contributing factors, including excessive alcohol consumption, smoking, stress, and certain medications such as steroids and anticoagulants 1
- Rare causes, such as Zollinger-Ellison syndrome, radiation therapy, and viral infections 1
- Genetic factors, which may also play a role in susceptibility 1
Treatment and Prevention
Treatment typically involves antibiotics combined with proton pump inhibitors for H. pylori eradication, or stopping NSAIDs and using acid-reducing medications for NSAID-induced ulcers 1. Lifestyle modifications, such as avoiding alcohol, quitting smoking, and stress management, can help prevent recurrence 1. It is essential to note that the management of peptic ulcer disease may involve various subspecialties, including surgeons, gastroenterologists, and radiologists, and successful management requires prompt recognition, resuscitation when required, appropriate antibiotic therapy, and timely surgical or radiological treatment 1.
Key Considerations
The most recent and highest quality study 1 highlights the importance of H. pylori infection in the development of peptic ulcer disease, and the need for effective treatment and prevention strategies to reduce the risk of complications and improve patient outcomes. Additionally, the study emphasizes the role of NSAID use in the development of peptic ulcer disease, and the need for careful consideration of the risks and benefits of NSAID use in patients with a history of peptic ulcer disease 1.
Recommendations
Based on the most recent and highest quality evidence, the primary recommendation for the management of peptic ulcer disease is to prioritize the eradication of H. pylori infection and the discontinuation of NSAID use, while also implementing lifestyle modifications to prevent recurrence 1. This approach can help to reduce the risk of complications, improve patient outcomes, and minimize the economic burden of peptic ulcer disease on the healthcare system.
From the Research
Causes of Peptic Ulcer Disease
The causes of peptic ulcer disease (PUD) can be attributed to several factors, including:
- Helicobacter pylori infection, which affects approximately 42% of patients with PUD 2
- Nonsteroidal anti-inflammatory drug (NSAID) use, which is an etiologic factor in approximately 36% of people with PUD 2
- Aspirin use, particularly "low-dose" aspirin therapy, which can cause ulcers 3
- Combination of H. pylori infection and NSAID use, which synergistically increases the risk of bleeding ulcers more than sixfold 4
Risk Factors
Certain risk factors can increase the likelihood of developing PUD, including:
- Age, with older persons being at higher risk of PUD due to high-risk medication use, such as antiplatelet drugs, warfarin, selective serotonin reuptake inhibitors, and bisphosphonates 5
- Gender, with women being more frequently affected by NSAID-related PUD 6
- Presence of alarm symptoms, such as bleeding or perforation, which require immediate medical attention 5, 4
Other Causes
Other causes of PUD include: