What is peptic ulcer disease and what is the fundamental imbalance that causes it?

Peptic ulcer disease (PUD) is ulceration of the GI mucosa exposed to acid and pepsin, arising when damaging forces (acid, pepsin, H. pylori, NSAIDs) overwhelm the mucosal protective factors (mucus, bicarbonate, prostaglandins, blood flow).

Clinical relevance. The balance concept frames why removing aggressive factors (H. pylori, NSAIDs) and boosting protection heals ulcers.

More Detail

Peptic ulcer disease

PUD is a common, chronic, recurring disease and an important cause of hospitalisation. It reflects an imbalance between aggressive and protective forces at the mucosa.

The balance

• Aggressive factors: gastric acid, pepsin, H. pylori, NSAIDs/aspirin.
• Protective factors: mucus layer, bicarbonate secretion, prostaglandins, mucosal blood flow, epithelial renewal.

Background

• Usually develops on a background of chronic gastritis, which distinguishes it from acute stress ulcers.
• Most cases are associated with H. pylori-induced hyperchlorhydric gastritis or NSAID use.

Sites

• Proximal (first part) duodenum is the commonest site (about 4 times commoner than gastric ulcers), usually within 1-2 cm of the pylorus.
• Gastric antrum (lesser curve), and less commonly oesophagus, Meckel's diverticulum, or jejunum after gastric surgery.