Peptic Ulcer Disease and Helicobacter pylori infection

Abstract

Peptic ulcer disease (PUD) is a common condition that both primary care providers and gastroenterologists encounter. Symptoms of peptic ulcer disease are variable and may include abdominal pain, nausea, vomiting, weight loss and bleeding or perforation with complicated disease. Identifying the risk factors and mechanisms that lead to the development of PUD helps to understand the approach behind diagnostic and treatment strategies.

Figure 1

Peptic erosions and ulcers in the stomach and duodenum. A. small erosions in the gastric antrum. Mucosal breaks with focal hemorrhage are identified by the arrows. B. Benign peptic ulcer in the body of the stomach (arrow). C. Duodenal erosions identified by focal areas of adherent exudate (arrows). D. Duodenal ulcer. The mucosal defect has depth and the margin is identified by the arrow. The surrounding mucosa is edematous.

Figure 2

Multiple treatment regimens for H. pylori can be considered and the standard treatment duration is 14 days. The doses of the drugs used are: proton pump inhibitor (PPI, standard or double dose), clarithromycin 500 mg BID, amoxicillin 1 gm BID, bismuth subsalicylate 300 mg QID, metronidazole 500 mg TID, tetracycline 500 mg QID, levofloxacin 500 mg QD, rifabutin 300 mg QD.