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JAMA Clinical Reviews

Diagnosis and Treatment of Peptic Ulcer Disease

Oct 28, 2024
In this insightful discussion, Nimish Vakil, a clinical professor and gastroenterologist from the University of Wisconsin, delves into the complexities of peptic ulcer disease. He outlines how H. pylori and NSAIDs are principal culprits, shedding light on recommended treatment regimens. Vakil clarifies misconceptions about diet and stress, noting their impact on symptoms but not on causing ulcers. He also addresses a troubling rise in non-H pylori cases among younger adults, emphasizing the need for targeted research and management.
21:43

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Quick takeaways

  • Peptic ulcer disease affects approximately 1% of the U.S. population, predominantly due to H. pylori infection and NSAID use.
  • Effective management requires a quadruple therapy regimen, followed by testing for H. pylori eradication and monitoring symptoms.

Deep dives

Prevalence and Presentation of Peptic Ulcer Disease

Peptic ulcer disease affects about 1% of the population, with approximately 54,000 hospital admissions annually due to this condition. Common symptoms include upper abdominal pain, discomfort, heartburn, and acid indigestion, which can be nonspecific and overlap with other gastrointestinal disorders like functional dyspepsia. Physical examination may only reveal localized epigastric tenderness, further complicating accurate diagnosis. Risk factors for developing peptic ulcers primarily include the use of non-steroidal anti-inflammatory drugs (NSAIDs) and infection with H. pylori, with the latter being particularly common in individuals born before the 1960s.

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