Peptic ulcer disease (PUD) is a common gastrointestinal condition affecting up to 10% of the world's population [4]. It involves a lesion of the mucosal lining in the upper gastrointestinal tract, which occurs due to an imbalance between aggressive digestive factors, such as gastric acid, and protective mucosal mechanisms [1], [4], [6]. When the mucosal defense is compromised, underlying tissues are exposed to acid-peptic damage [6]. The two primary underlying causes of PUD are infection with the bacterium Helicobacter pylori and the use of nonsteroidal anti-inflammatory drugs (NSAIDs), including low-dose aspirin [2], [3], [5]. Additional contributing factors include smoking and alcohol abuse [6].
Recognizing Symptoms of Peptic Ulcers
The clinical presentation of peptic ulcers can vary depending on the patient's age and the location of the ulcer. A classic symptom of duodenal and gastric ulcers is abdominal pain, which frequently manifests as pain that awakens the patient from sleep between midnight and 3 a.m. [2]. However, symptoms differ significantly in older populations: adults over the age of 80 often do not present with typical abdominal pain [2]. Instead, older patients are more likely to experience epigastric pain, nausea, and vomiting [2]. If left untreated, peptic ulcers can lead to serious complications such as bleeding and perforation [6]. A perforated peptic ulcer typically presents with a sudden onset of severe abdominal pain or an acute worsening of existing discomfort [6].
Diagnostic Approaches for PUD
Accurate diagnosis is essential to guide appropriate management and rule out malignancies. For patients younger than 55 without alarm symptoms who are at a low risk for gastric cancer, clinicians often use a non-invasive 'test-and-treat' strategy for H. pylori [3]. Urea breath tests and stool antigen tests are highly accurate methods for identifying active H. pylori infection and can also be used to confirm successful eradication after treatment [3]. While serologic blood tests offer a convenient alternative for detection, they are less accurate and cannot confirm whether an infection has been successfully cured [3]. Most other patients, particularly older individuals or those with alarm symptoms, typically undergo upper endoscopy to visualize the mucosa, rule out cancer, and investigate other causes of dyspepsia [3], [5]. Abdominal X-rays and CT scans are useful for diagnosing perforated ulcers [6].
Conventional Pharmacological Treatments
Current medical management focuses heavily on eradicating H. pylori, suppressing gastric acid, and preventing complications [5]. Standard acid-suppression medications include proton pump inhibitors (PPIs) and histamine-2 (H2) receptor antagonists [4], [5], [8]. Newer therapeutic options include potassium-competitive acid blockers (P-CABs), which offer rapid and potent acid suppression as an alternative to PPIs [5]. When H. pylori is present, eradication regimens may include standard triple therapy (though limited by clarithromycin resistance), sequential therapy, bismuth-based quadruple therapy, or levofloxacin-based regimens [3], [7]. Because chronic NSAID use combined with an H. pylori infection dramatically increases ulcer risk [3], minimizing unnecessary NSAID use is a key preventive strategy. In severe cases involving complications like perforation or bleeding, minimally invasive surgical techniques or traditional surgery may be necessary [6], [8].
Nutritional Care and Dietary Support
Dietary management and nutritional therapy play a supportive role in the prevention and recovery phases of peptic ulcer disease [1]. Caloric distribution and dietotherapy should be tailored to individual patient needs to normalize nutritional status and support mucosal healing [1]. Nutritional requirements can shift between the acute phase and the recovery phase of the condition [1]. During recovery, patients often have an increased need for protein and specific micronutrients, including vitamin A, vitamin C, zinc, and selenium [1]. Furthermore, some clinical studies indicate that vitamin C may provide a beneficial adjuvant effect in supporting the eradication of H. pylori [1].
Sources
- 1. Nutritional care in peptic ulcer
- 2. Peptic ulcer disease
- 3. Diagnosis and Treatment of Peptic Ulcer Disease and H. pylori Infection
- 4. Peptic Ulcer Disease: A Brief Review of Conventional Therapy and Herbal Treatment Options
- 5. Review of Peptic Ulcer Disease: Insights from Pathophysiology, Mechanisms, Pharmacotherapy, Phytotherapy, and Case Reports
- 6. A Review on Treatment of Perforated Peptic Ulcer by Minimally Invasive Techniques
- 7. Peptic Ulcer Disease
- 8. Peptic Ulcer Disease: A Comprehensive Review on Conventional Therapy and Herbal Treatment