Gastroenterology
Peptic Ulcer Disease
소화성궤양
Mucosal break in stomach or duodenum extending into muscularis mucosa
- How common
- Lifetime 5–10%
- Typical age
- Middle-aged and older
What is it?
Imbalance between aggressive factors (acid, pepsin, H. pylori, NSAIDs) and defenses (mucus, bicarbonate, prostaglandins) creates ulcer.
Commonly affected: Gastric antrum (lesser curve), duodenal bulb
How it develops
- Defense breachNSAIDs block COX-1 → reduced prostaglandins
- Aggression upH. pylori, acid, pepsin damage mucosa
- Ulcer formationDefect extends into muscularis mucosa
- ComplicationsBleeding, perforation, obstruction, malignancy
Symptoms
- Melena/hematemesisBleeding complication
- Epigastric painDU: hunger pain; GU: postprandial pain
- Nocturnal painWakes at 1-3 AM with pain
- Dyspepsia/bloatingEarly satiety
- Weight lossAvoidance of food
How it is examined
- Epigastric tendernessLocalized epigastric tenderness
- DRECheck melena/occult blood
- Peritoneal signsBoard-like rigidity if perforation
Imaging
Upright CXR/AXR for free air under diaphragm if perforation suspected.
- Free air under diaphragm
- Pneumoperitoneum
EGD is gold standard; biopsy and H. pylori testing concurrent.
- Active ulcer
- Healing ulcer
- Suspicious for malignancy
Non-surgical care
- PPI 8 weeksOmeprazole 20mg or esomeprazole 40mg QD
- Stop NSAIDsIf needed, COX-2 selective + PPI
- Eradicate H. pyloriTriple or quadruple therapy if positive
- Quit smoking/alcoholPromotes healing, reduces recurrence
- MisoprostolPGE1 analog for mucosal protection
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
Perforation, massive bleeding, failed endoscopy, gastric outlet obstruction, malignancy
Procedures that may be discussed
- Emergency Graham patch repair
- Endoscopic hemostasis (clip/cautery/injection)
- Vagotomy + pyloroplasty
- Partial gastrectomy
Outlook
>90% healing with H. pylori eradication and NSAID cessation; <10% 1-yr recurrence.