Peptic Ulcer Disease

The primary causes of peptic ulcers are hyperacidity, Helicobacter pylori, and NSAIDs. Gastric ulcers are less common than duodenal ulcers; gastric ulcers may be malignant in 5–8%. UGIE is the preferred method for diagnosis and biopsy in cases of gastric ulcer. The treatment for uncomplicated peptic ulcers is mainly medication; surgery is reserved for stubborn ulcers and complications. Gastric antisecretory agents and H. pylori eradication therapy are the cornerstones of peptic ulcer management. Common complications of peptic ulcers include bleeding, perforation, and stenosis or outlet obstruction. Posterior duodenal ulcer more commonly bleeds, while anterior duodenal ulcer perforates. The gastroduodenal artery in cases of duodenal ulcer and the left gastric artery in gastric ulcer need to be surgically transfixed if endoscopic management fails. An acid-reducing procedure (vagotomy) must be performed in cases of duodenal ulcer bleeding to prevent recurrence. A perforated peptic ulcer is a surgical emergency. The patient must be adequately resuscitated before surgical intervention. Gastric outlet obstruction is treated by a bypass procedure combined with vagotomy.