Overview
Definition
A defect in the gastric or duodenal mucosa that extends through the muscularis mucosae into the deeper layers of the wall.
Epidemiology
Very common, affecting ~10% of the population at some point in their lives.
Etiology & Risk Factors
- Helicobacter pylori infection (most common cause)
- NSAID and Aspirin use (inhibits protective prostaglandins)
- Zollinger-Ellison syndrome (gastrinoma)
- Physiologic stress (Cushing/Curling ulcers in ICU patients)
Clinical Symptoms
- Dyspepsia / Epigastric pain
- Duodenal ulcers: Pain improves with meals (acid buffered by food), then worsens 2-3 hrs later
- Gastric ulcers: Pain worsens immediately with meals (acid secretion triggered by food) causing weight loss
- Melena or Hematemesis (if bleeding occurs)
Clinical Approach
Diagnosis
- Esophagogastroduodenoscopy (EGD) - Gold Standard for visualization and biopsy (to rule out malignancy in gastric ulcers)
- H. pylori testing (Urea breath test, stool antigen, or mucosal biopsy)
Management
- Proton Pump Inhibitors (PPIs) for acid suppression
- Discontinue NSAIDs/Aspirin if possible
- H. pylori eradication (e.g., Quadruple therapy: Bismuth, Metronidazole, Tetracycline, PPI)
- Surgical intervention for perforated or refractory bleeding ulcers
Complications
- Gastrointestinal bleeding (most common)
- Perforation (leading to peritonitis, evident by pneumoperitoneum on imaging)
- Gastric outlet obstruction