PEPTIC ULCER DISEASE: ETIOPATHOGENESIS, COMPLICATIONS, AND MODERN TREATMENT APPROACHES
Keywords:
Peptic ulcer disease, Helicobacter pylori, NSAID-induced ulcer, bismuth quadruple therapy, vonoprazan, upper gastrointestinal bleeding, perforation, gastric outlet obstruction, test-and-treat.Abstract
Background: Peptic ulcer disease (PUD) remains a common cause of upper gastrointestinal morbidity worldwide, arising when aggressive factors — chiefly Helicobacter pylori infection and nonsteroidal anti-inflammatory drug (NSAID) use — overwhelm the mucosal defenses that normally protect the gastric and duodenal epithelium from acid-peptic injury.
Methods: This narrative review synthesizes current evidence on the etiopathogenesis, complications, and treatment of PUD, drawing on the 2024 American College of Gastroenterology (ACG) clinical guideline for the treatment of Helicobacter pylori infection and contemporary reviews of NSAID-related and complicated peptic ulcer disease.
Results: H. pylori infection and NSAID use, alone or synergistically, account for the great majority of peptic ulcers, with acid-pepsin hypersecretion, smoking, and physiologic stress acting as additional aggressive factors against a mucosal defense system built on the mucus-bicarbonate barrier, prostaglandin-mediated cytoprotection, adequate mucosal blood flow, and epithelial renewal. Management now follows a test-and-treat paradigm in patients under 60 without alarm features, reserving endoscopy for older patients or those with alarm symptoms, and increasingly favors bismuth quadruple therapy or vonoprazan-based regimens over legacy clarithromycin-based triple therapy in regions with rising antibiotic resistance. Complications — bleeding, perforation, gastric outlet obstruction, penetration, and, for gastric ulcers, malignant transformation — carry distinct presentations and management pathways and remain the primary drivers of PUD-related mortality.
Conclusion: Because most peptic ulcers are now preventable and curable through correct identification and elimination of their causative aggressive factor, systematic H. pylori testing and eradication, judicious NSAID use with appropriate gastroprotection, and prompt recognition of complications are central to modern PUD care, including in resource-limited settings such as Uzbekistan, where the test-and-treat strategy and basic endoscopy remain the most practical and impactful tools available.
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