Peptic ulcer disease

### What you need to know Peptic ulcer disease presents with gastrointestinal symptoms similar to dyspepsia and can be difficult to distinguish clinically. It can have potentially serious complications such as bleeding or perforation, with a high risk of mortality.1 Optimal treatment with proton pump inhibitors (PPIs) facilitates healing and can prevent complications and recurrence. Observational studies and surveys among healthcare providers report that adherence to evidence based treatment guidelines is often poor.23456789 This results in inadequate treatment and overuse of PPIs. Increasingly, antibiotic resistance has affected the choice of eradication regimen for Helicobacter pylori infection, the main risk factor. In this Clinical Update, we review the epidemiology and management of peptic ulcer disease for non-specialists to guide prompt diagnosis and appropriate treatment. Peptic ulcer disease is often defined as a mucosal break greater than 3-5 mm in the stomach or duodenum with a visible depth. It is therefore an endoscopic diagnosis in contrast to dyspepsia, which is a clinical diagnosis based on symptoms alone. Peptic ulcer disease results from an imbalance between factors that protect the mucosa of the stomach and duodenum, and factors that cause damage to it (fig 1). …