Peptic ulcer disease (PUD) is a group of disorders involving the upper gastrointestinal (GI) tract. A peptic ulcer is a defined, abraded area of the GI mucosa, typically located in the stomach or the first few centimeters of the duodenum, the first section of the small intestine.(1) Peptic ulcers can be acute or chronic. Duodenal and gastric ulcers are the most common types of chronic peptic ulcers.

Investigators have divided PUD into three groups: 1) those with massive acid secretion (i.e., Zollinger-Ellison syndrome); 2) ulcers caused by infection; and 3) those caused by the use of nonsteroidal anti-inflammatory drugs (NSAIDs).(2)

The body and upper portion of the stomach are made up of glands which secrete acid called oxyntic glands. When stimulated by a physiologic event (for instance, a meal), some of the cells secrete hydrochloric acid, while other cells secrete pepsinogen. In an acidic environment, pepsinogen forms pepsin.

Several mechanisms preserve the gastric mucosa and protect it from the digestive effects of pepsin and acid. Surface cells and mucus cells act as first line defenses by secreting mucus and bicarbonate throughout the gastric area. Bicarbonate, along with mucus, is thought to provide a layer over epithelial cells where the pH is neutral. Beneath the surface epithelium, a dense network of capillaries provides another level of defense. Another way in which the epithelium resists injury from acids is through rapid and continual cell renewal.

A number of factors can be risk factors for PUD, including:

• Hypersecretion of gastric acid
• Inflammatory response associated with Helicobacter pylori;
• Direct irritation of the GI mucosa
• NSAIDs and ASA use
• Cigarette smoking
• Genetic predisposition
• Diet, use of alcohol
• Psychological stress

One contributor to recurrent peptic ulcer disease is an organism called Helicobacter pylori (H. pylori), a spiral shaped bacterium discovered in 1982 that is found in the gastric mucus layer or in the lining of the stomach.(3) This organism is found in 95 percent of patients with duodenal ulcers and 70 percent of patients with gastric ulcers.(4) Getting rid of the organism significantly decreases the recurrence rate and accelerates the healing rate of ulcers.(5)

It is not known how H. pylori is transmitted, but it is most likely spread from person to person through fecal-oral or oral-oral routes. The prevalence of H. pylori increases with age. It is not known exactly how the bacteria causes damage because many people infected with H. pylori never develop ulcers.(6) Persons with active gastric or duodenal ulcers or a documented history of ulcers should be tested for H. pylori, and if found to be infected, should be treated.