Peptic ulcers involve ulceration of the mucosa of the stomach (gastric ulcer) or the duodenum (duodenal ulcer).

Epidemiology:

• DUs affect 10% of the adult population and are 2-3x more common than GUs
• in the developing world they are more likely related to h.pylori infection
• in the developed word, more likely NSAID related

Pathophysiology

The stomach mucosa is prone to ulceration from:

• Breakdown of the protective layer of the stomach and duodenum
• Increase in stomach acid

ulcerations consist of a break in the superficial epithelial cells penetrating down into the muscularis mucosa - there is a fibrous base and an increase in inflammatory cells

Risk factors

• Helicobacter pylori is associated with the majority of peptic ulcers:
  • 95% of duodenal ulcers
  • 75% of gastric ulcers
• drugs:
  • NSAIDs - 50% of patients on NSAIDs have gastric mucosal damage
  • SSRIs
  • corticosteroids
  • bisphosphonates
• Zollinger-Ellison syndrome: rare cause characterised by excessive levels of gastrin, usually from a gastrin secreting tumour
• the role of alcohol and smoking is not clear

PC