Peptic ulcer disease (PUD) and gastritis (inflammation of the stomach) have very similar causes and so are usually discussed together. PUD can occur in the stomach or the duodenum (the first part of the small bowel). Both PUD and gastritis can cause similar symptoms – pain in the upper abdomen being the most important. Other symptoms include nausea, vomiting, loss of appetite, weight loss and variation with eating (getting better or worse).

When severe, peptic ulcer disease can lead to complications. These include:

• Bleeding - may be life-threatening
• Perforation - if an ulcer penetrates the stomach wall; surgery is usually indicated
• Obstruction of the stomach outlet

The two most common causes of PUD and gastritis are:

• Non-steroidal anti-inflammatory drugs (NSAIDs) – e.g. Aspirin, ibuprofen, diclofenac, Grandpa tablets.
• Helicobacter pylori – A bacteria that colonizes the stomach, causing disturbances in the normal gastric physiology.

Diagnosis

The best way to diagnose these conditions is to perform a gastroscopy. This allows direct visualization of the stomach and duodenum, as well as collection of biopsy samples for examination. These samples can help to establish a cause for the ulcer and also determine if it is cancerous. H. pylori can be tested for using a special kit in the endoscopy room, without needing to send specimens away for histological examination.

Treatment

The treatment of PUD and gastritis involves the following:

1.) If a cause is found: Removal of the cause e.g.:

• Eradication of H. pylori using antibiotics
• Discontinuation of NSAIDs

2. ) Therapy with anti-acid therapy.

The duration depends on the cause and the severity of disease. The most effective and most commonly used class of anti-acid therapy is called proton pump inhibitors. This is a very safe class of drugs that is widely used.

3.) Follow-up

Gastric ulcers do carry a small risk of being cancerous and so should always be biopsied. Duodenal ulcers have a very low chance of being malignant, so are seldom biopsied unless they look atypical or are not healing. Gastric ulcers should always have a follow-up gastroscopy to confirm that they have healed, usually around 8 weeks after commencing treatment.