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.
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.
Role of H. pylori in Peptic Ulcer Disease
H. pylori infection is a major cause of peptic ulcer disease, with studies indicating that 70-90% of peptic ulcer cases involve this bacterium. However, not everyone infected with H. pylori will develop ulcers; about 10% lifetime prevalence is observed in infected individuals. Testing for H. pylori is recommended when symptoms suggest its involvement, as treating the infection can lead to symptom resolution in many patients. Non-invasive testing options like the breath test and stool antigen test are preferred over serologic tests due to their accuracy in confirming active infections.
Recent Trends and Management Strategies
There is a growing incidence of non-H. pylori, non-NSAID related ulcers, particularly in younger populations, although the underlying causes remain unclear. The management of peptic ulcers includes a treatment regimen of quadruple therapy, which is deemed effective and involves a proton pump inhibitor along with antimicrobial agents. Following a two-week treatment, it is advisable to test for successful eradication of H. pylori and assess symptoms thereafter. In the event of persistent symptoms without H. pylori, a trial of acid reduction therapy with a proton pump inhibitor may be initiated prior to considering more invasive procedures like endoscopy.
Peptic ulcer disease affects approximately 1% of the population in the US, and H pylori is a common cause of peptic ulcer disease. Author Nimish Vakil, MD, a gastroenterologist from the University of Wisconsin, Madison, discusses current evidence regarding diagnosis and treatment of peptic ulcer disease with JAMA Deputy Editor Mary McGrae McDermott, MD. Related Content: