Article Sections

Introduction

Peptic ulcer disease (PUD) encompasses defects in the gastrointestinal (GI) mucosa, including the stomach and/or proximal duodenum ( Figure 1), that extend through the muscularis mucosae ( Figure 2).  These ulcers are caused by an imbalance between mucosal defense mechanisms and aggressive luminal factors, such as gastric acid and pepsin.  The 2 most common etiologies are Helicobacter pylori infection and the use of nonsteroidal anti-inflammatory drugs (NSAIDs).  PUD is one of the most common causes of upper GI bleeding.

Pathophysiology

Normally, the gastric mucosa is protected from highly acidic gastric contents by a thick layer of mucus and bicarbonate (assisted by vasodilatory effects of prostaglandin secretion) and tight junctions between epithelial cells.  Different types of cells and glands are present in the stomach ( Figure 3

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