Peptic Ulcer Disease (PUD) – Causes, Symptoms, Diagnosis, Treatment

Peptic Ulcer Disease (PUD) is a common yet potentially serious gastrointestinal condition where open sores or lesions develop in the lining of the stomach, duodenum, or esophagus due to the corrosive effects of gastric acid and digestive enzymes. Understanding this condition is crucial for healthcare professionals, students preparing for medical exams like NCLEX, and individuals who may be at risk.

In this comprehensive article, we will explore the pathophysiology, signs and symptoms, risk factors, complications, diagnostic tools, pharmacological management, patient education, and clinical exam insights to ensure a 360-degree understanding of PUD.

Understanding the Pathophysiology of Peptic Ulcer Disease

Peptic Ulcer Disease occurs when the natural protective barriers of the gastrointestinal mucosa are overwhelmed by the damaging effects of gastric acid and pepsin. This imbalance results in mucosal erosion and ulcer formation.

How it develops:

• Normally, the stomach and duodenum are lined with mucus and bicarbonate that protect against acid damage.
• When these defenses are disrupted—due to factors like Helicobacter pylori infection, NSAID use, or severe stress—acid penetrates deeper layers of the mucosa.
• This creates an inflammatory reaction, tissue destruction, and ultimately an ulcer.

Types of Peptic Ulcers:

• Gastric Ulcers: Occur in the stomach lining, often worsening after meals.
• Duodenal Ulcers: Occur in the first part of the small intestine, often improving temporarily with food but recurring a few hours later.

Signs and Symptoms of Peptic Ulcer Disease

The symptoms of PUD can vary depending on the ulcer location, severity, and presence of complications. Recognizing these patterns is essential for early diagnosis.

Gastric Ulcer Symptoms

• Pain in the epigastric region or radiating to the back
• Pain worsens 30–60 minutes after meals
• Weight loss due to fear of eating
• Nausea, vomiting, and possible hematemesis (vomiting blood)

Duodenal Ulcer Symptoms

• Pain 2–3 hours after meals or at night
• Pain relieved temporarily by eating
• Weight gain due to eating for pain relief
• Possible melena (black, tarry stools from GI bleeding)

General Dyspeptic Symptoms:

• Burning or gnawing abdominal pain
• Bloating
• Early satiety
• Indigestion

Major Causes and Risk Factors

PUD has multiple causes, but three major risk factors dominate clinical cases.

1. Helicobacter pylori infection – The most common cause, weakening mucosal defenses.
2. NSAID use – Drugs like naproxen, ibuprofen, and indomethacin reduce prostaglandin production, lowering mucus secretion.
3. Severe stress – Prolonged physiological or psychological stress can worsen ulcers, common in ICU patients or students under intense academic pressure.

Other contributing factors:

• Smoking (reduces mucosal blood flow)
• Alcohol overuse
• Excessive caffeine
• Genetic predisposition

Complications of Peptic Ulcer Disease

If untreated, PUD can lead to life-threatening complications.

1. Perforation

• Sudden, severe abdominal pain
• Rigid or "board-like" abdomen
• Rebound tenderness
• Signs of peritonitis (fever over 100.3°F, tachycardia, tachypnea)

2. Hemorrhage (GI Bleeding)

• Hematemesis (vomiting blood)
• Melena (black, tarry stools)
• Fatigue and pallor from anemia

3. Gastric Outlet Obstruction

• Persistent vomiting
• Abdominal distension
• Dehydration and electrolyte imbalance

Diagnosis of Peptic Ulcer Disease

Endoscopic Examination (EGD)

• Gold standard for diagnosis
• Allows direct visualization and biopsy for H. pylori testing

Upper GI Series with Barium Contrast

• Useful when endoscopy is unavailable
• Detects ulcer location and obstruction

Laboratory Tests

• H. pylori testing (urea breath test, stool antigen, biopsy urease test)
• CBC for anemia
• Stool occult blood test

Pre-procedure patient instructions:

• NPO (nothing by mouth) for at least 8 hours before procedure
• Avoid smoking
• Expect temporary chalky stool after barium studies

Pharmacological Management

Treatment aims to eliminate H. pylori, reduce gastric acidity, protect the mucosa, and prevent recurrence.

1. Eradicating H. pylori

• Amoxicillin
• Clarithromycin
• Tetracycline
• Metronidazole
• Bismuth subsalicylate (Pepto-Bismol)

2. Acid Reduction

• H2 receptor blockers: Ranitidine, Famotidine
• Proton pump inhibitors (PPIs): Omeprazole, Pantoprazole

3. Mucosal Protection

• Sucralfate
• Misoprostol (especially in NSAID-induced ulcers)

Patient Education for Peptic Ulcer Disease

Patient education is vital in preventing recurrence and managing symptoms.

• Diet: Avoid spicy, fatty, fried, and acidic foods
• Avoid caffeine, alcohol, and smoking
• Manage stress through relaxation techniques
• Report black, tarry stools or vomiting blood immediately
• Complete full course of medications for H. pylori eradication

Exam Tips (NCLEX & Nursing School)

• Gastric ulcer pain increases with food; duodenal ulcer pain decreases with food initially.
• Always report signs of perforation or GI bleeding immediately.
• PPIs are more effective than H2 blockers in healing ulcers.
• Avoid NSAIDs unless absolutely necessary.

Table: Gastric vs. Duodenal Ulcer Characteristics

Feature	Gastric Ulcer	Duodenal Ulcer
Pain Timing	30–60 min after meals	2–3 hrs after meals / at night
Effect of Food	Worsens pain	Relieves pain temporarily
Weight Change	Weight loss	Weight gain
Bleeding	Hematemesis	Melena

Frequently Asked Questions

Q1: Is Peptic Ulcer Disease curable?

Yes, most cases are curable with proper treatment, especially if caused by H. pylori. Eradication therapy significantly reduces recurrence.

Q2: Can stress alone cause ulcers?

Stress may not directly cause ulcers but can worsen existing lesions and delay healing.

Q3: Can ulcers turn into cancer?

Gastric ulcers, if untreated, may increase the risk of gastric cancer, especially with chronic H. pylori infection.

Q4: How long does ulcer healing take?

With treatment, ulcers usually heal within 4–8 weeks.

Q5: Should I stop coffee if I have PUD?

Yes, coffee stimulates acid production and may worsen symptoms.