Dr. Kumar’s Take:
Peptic ulcer disease (PUD) is still a common and serious condition, but the story has changed over the years. Once thought to be caused mostly by stress and diet, we now know that most ulcers are caused by Helicobacter pylori infection or long-term use of NSAIDs like ibuprofen. The good news is that with modern testing and treatment, ulcers are usually manageable. For patients, the key take-home point is that ongoing stomach pain should not be ignored, and lifestyle changes plus targeted treatment can make a huge difference.
Key Takeaways:
✔ H. pylori infection causes up to 90% of duodenal ulcers and 70–90% of gastric ulcers.
✔ NSAIDs like ibuprofen and aspirin are the second most common cause of ulcers.
✔ Proton pump inhibitors (PPIs) and antibiotics remain first-line therapy.
✔ Smoking, alcohol, and obesity can worsen or increase the risk of ulcers.
✔ Untreated ulcers can lead to bleeding, perforation, or even cancer.
Actionable Tip:
If you take NSAIDs regularly or have persistent stomach pain, ask your doctor about testing for H. pylori and whether you should be on protective medications like a acid blockers.
Brief Summary:
Peptic ulcer disease involves breaks in the stomach or duodenal lining caused by acid and pepsin. The StatPearls 2023 update highlights that H. pylori and NSAIDs are the leading causes. Patients may experience burning stomach pain, bloating, nausea, or bleeding. The condition is usually diagnosed with endoscopy or non-invasive H. pylori testing. Most patients respond well to PPI-based triple therapy and lifestyle changes.
Study Design:
This StatPearls review (updated June 2023) summarizes epidemiology, etiology, diagnosis, and treatment. It synthesizes data from randomized controlled trials, consensus guidelines (like the Maastricht V/Florence consensus), and clinical practice guidelines from gastroenterology societies.
Peptic Ulcer Disease:
- Epidemiology: Lifetime risk of 5–10%. Rates have declined globally with sanitation and modern therapies.
- Etiology: H. pylori and NSAIDs are the most common causes; stress, malignancy, and rare disorders also contribute.
- Symptoms: Gastric ulcer pain often worsens after meals, while duodenal ulcer pain improves with food but returns hours later.
- Diagnosis: Endoscopy remains gold standard; urea breath and stool antigen tests are highly accurate for H. pylori.
- Treatment: PPIs plus antibiotics are first-line for H. pylori. NSAID-induced ulcers improve after stopping the drug and using acid suppression. Surgery is reserved for refractory cases or complications.
Biological Rationale:
H. pylori produces urease and toxins (CagA, VacA) that damage the stomach lining. NSAIDs reduce protective prostaglandins. Together, these weaken mucosal defenses, allowing acid and pepsin to cause ulcers.
Practical Lifestyle Changes:
- Avoid unnecessary NSAID use, or take the lowest dose possible.
- Stop smoking and limit alcohol and caffeine.
- Maintain a healthy weight, as obesity raises ulcer risk.
- Manage stress, as it can worsen symptoms.
Related Studies and Research
Podcast: Stomach Full of Courage – H. pylori and Ulcers – The true story of how bacteria—not stress—caused ulcers.
H. pylori Discovery: Game-Changing Study – The research that overturned decades of false beliefs about ulcers.
Barry Marshall’s Nobel Lecture – His personal account of the skepticism, struggle, and triumph.
Frequently Asked Questions
What is the most common cause of peptic ulcers?
Most ulcers are caused by H. pylori infection or NSAID use.
How are ulcers diagnosed?
Doctors may use breath tests, stool antigen tests, blood tests, or an upper endoscopy.
Can ulcers lead to cancer?
Yes, untreated H. pylori infection increases the risk of gastric cancer.
Are ulcers curable?
Yes. With PPIs and antibiotics, most patients achieve healing and long-term relief.
Conclusion:
Peptic ulcer disease remains a major but manageable health problem. With recognition of H. pylori and NSAID-related risk, plus modern therapy, outcomes are excellent. The key is early recognition, proper testing, and a combination of medication and lifestyle adjustments.