date: “2024-01-01” title: definition and etiologies of peptic ulcer disease alias: eti-PUD
definition and etiologies of peptic ulcer disease
(BMJ 2019;367:5495)
- 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