From the Research
Approximately 1-2% of peptic ulcers in adults aged 30 are malignant. This low percentage reflects the fact that most peptic ulcers in younger adults are benign and caused by either Helicobacter pylori infection or NSAID use, as supported by a recent review published in JAMA 1. Malignancy becomes a more significant concern in older adults, particularly those over 50 years of age. Despite the low likelihood of malignancy in 30-year-olds, any persistent or concerning symptoms such as weight loss, anemia, vomiting, or ulcers that don't heal with appropriate therapy should prompt further investigation.
Some key points to consider in the management of peptic ulcers include:
- The importance of Helicobacter pylori infection and NSAID use as causes of peptic ulcers, with approximately 42% of patients with peptic ulcer disease having H. pylori infection and 36% having NSAID use as etiologic factors 1.
- The role of endoscopy with biopsy in definitively diagnosing peptic ulcer disease and ruling out malignancy.
- The effectiveness of acid blockers, such as omeprazole, in healing peptic ulcers, with approximately 80% to 100% of patients achieving healing within 4 weeks 1.
- The importance of eradicating H. pylori to decrease peptic ulcer recurrence rates, with recurrence rates decreasing from approximately 50% to 60% to 0% to 2% after eradication 1.
In terms of treatment, endoscopy with biopsy remains the gold standard for definitively ruling out malignancy in any suspicious ulcer. For most young adults with typical symptoms, treatment focusing on H. pylori eradication (using clarithromycin-based triple therapy or bismuth quadruple therapy) and/or discontinuation of NSAIDs, along with proton pump inhibitors, will effectively address benign peptic ulcers. It is also important to note that long-term therapy with a proton pump inhibitor may be useful in patients with H. pylori-negative ulcers, which are more aggressive and have higher recurrence rates 2.