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New Treatments for Peptic Ulcer Disease

Peptic ulcer disease is diagnosed in 500,000 patients each year in the United States. A similar number of patients with ulcers go undiagnosed because they do not seek medical attention but treat themselves using non-prescription drugs.

Pathophysiology

Helicobacter pylori (HP), a spiral-shaped, flagellated organism, is the most frequent cause of peptic ulcer disease (PUD). Nonsteroidal anti-inflammatory drugs (NSAIDs) and pathologically high acid-secreting states (Zollinger-Ellison syndrome) are less common causes.

More than 90% of ulcers are associated with H. pylori. Eradication of the organism cures and prevents relapses of gastroduodenal ulcers. All patients with PUD and documented HP infection should be treated for HP.

In those taking NSAIDs chronically, more than 50% develop gastric erosions and up to a third have gastric ulceration. Duodenal ulceration occurs in 5% of chronic users.

Complications of peptic ulcer disease include bleeding, duodenal or gastric perforation, and gastric outlet obstruction (due to inflammation and edema or strictures) ulsers.

Clinical Evaluation

Symptoms of PUD include recurrent upper abdominal pain and discomfort. The pain of duodenal ulceration is often relieved by food and antacids and worsened when the stomach is empty (eg, at nighttime). In gastric ulceration, the pain may be exacerbated by eating.

Nausea aud vomiting are common in PUD. Hematemesis ("coffee ground" emesis) or melena (black tarry stools) are indicative of bleeding.

Physical Examination. Tenderness to deep palpation is often present in the epigastrium, and the stool is often guaiac-positive.

Laboratory Detection of Helicobacter Pylori Infection

Non-endoscopic Diagnostic Studies for H Pylori Infection

For the initial diagnosis, serologic testing is recommended for most patients with uncomplicated PUD.