Definition etiologies peptic ulcer disease

• Ulcers (break in mucosal lining >5 mm) & erosions (<5 mm) in stomach and duodenum

• Principal risk factors: H. pylori infection >ASA/NSAID use

• H. pylori infection: causes ~80% of duodenal ulcers (DU) & ~30–40% of gastric ulcers (GU). ~50% of world colonized w/ H. pylori, but only 5–10% will develop PUD.

• ASA/NSAIDs: damage to mucosa caused by ↓ prostaglandin synthesis. Cause majority of non–H. pylori-related DU & GU. Regular use a/w 5–6× ↑ odds of GIB.

• Other: smoking, stress, excessive EtOH, gastric cancer/lymphoma, Crohn’s, viral infxn (eg, CMV/HSV in immunosupp), bisphosphonates, steroids (in combo w/ NSAIDs, but not risk factor alone); rarely gastrinoma (Zollinger-Ellison synd.), mastocytosis, idiopathic

• Stress ulcer: risk factors = ICU & coagulopathic, mech vent, h/o GIB, steroid use; Rx w/ PPI