2. Epidemiology

PUD affects about 4.5 million persons per year in the United States (US) and causes huge healthcare cost of about \$3.3. billion/year [4]. The prevalence of PUD varies with the prevalence of Helicobacter pylori (H. pylori) infection. In the United States, the seroprevalence of H. pylori infection varies with age: 16.7% in young age (20–29 years) group and 56.9% in older age (>70 years) group. It is also different among different ethnicities: non-Hispanic whites 26.2%, non-Hispanic blacks 52.7%, and Mexican Americans 61.6% [5]. In developing countries, the prevalence

of infection can be as high as 90% [6]. Systematic review of the literature from developed countries estimated that the global incidence and prevalence of physician-diagnosed PUD were 0.10–0.19% and 0.12–1.50%, respectively. But the incidence and prevalence of PUD have decreased with the universal use of acid suppressant therapy and decrease in prevalence of Helicobacter pylori infection due to improved socioeconomic status and eradication of H. pylori infection after detection [7].

ulcer [18]. The gastric metaplasia becomes inflamed by H. pylori infection which

There are certain unusual causes of PUD which we come across now and then in

Gastrinoma or Zollinger-Ellison syndrome may present as multiple gastric and duodenal ulcers and accounts for 0.1% or more cases of PUD [20]. Other hormone (histamine)-mediated PUD include systemic mastocytosis, polycythemia vera, and

Besides NSAIDs and low-dose aspirin, few other medications can cause PUD. These include clopidogrel (in combination with NSAIDs), corticosteroids (in combination with NSAIDs), bisphosphonates, potassium chloride, spironolactone, sirolimus, mycophenolate mofetil, hepatic artery infusion of 5-fluorouracil, and

PUD can be due to another helicobacter infection called Helicobacter heilmannii [23]. Gastrointestinal ulcerations due to cytomegalovirus, herpes simplex virus,

Certain infiltrative diseases like Crohn's disease and sarcoidosis can present like

Family history is an independent risk factor for the development of PUD [25]. Blood group O individuals have higher susceptibility of getting H. pylori infection [26] and are 35–40% more prone to develop duodenal ulcer than people with other blood groups [27]. Salivary secretory status of A, B, and H antigens was also found to be significant. Nonsecretor phenotypes of ABH antigens are more susceptible to develop H. pylori infection and duodenal ulcer [28]. Genetic influence on the formation of PUD is modest, and it is independent of the genetic susceptibility of acquiring H. pylori infection [29]. Other risk factors for the development of PUD

When we think about the pathogenesis of PUD, we must consider two factors:

1. Mucosal protective factors: gastric mucus layer, prostaglandin, bicarbonate,

2. Mucosal damaging factors: gastric acidity, pepsin, H. pylori infection, and

Patients with PUD may be symptomatic or asymptomatic. Symptomatic patients generally present with dyspepsia, i.e., upper abdominal pain or discomfort. Most of the time, the pain is felt in the epigastric region, but sometimes it can be in the right upper quadrant or left upper quadrant of the abdomen. The pain is burning, gnawing, or dull aching in nature and generally non-radiating but rarely can radiate to the back in the case of posterior penetrating ulcer. Patients with gastric ulcer may feel pain shortly after taking food, but in the case of duodenal ulcer, pain is generally felt 2–3 h after taking meal, or sometimes patients wake up at night with epigastric pain. Duodenal ulcer pain is generally relieved after taking antacids or food which has minimal effect on relieving gastric ulcer pain [31]. Sometimes patients may feel gas and bloating sensation in the abdomen and sometimes may

PU occurs when there is an imbalance between these factors.

disrupts mucosal regeneration leading to duodenal ulcer formation [19].

our clinical practice.

Peptic Ulcer Disease

PUD [24].

basophilia in myeloproliferative diseases [21].

DOI: http://dx.doi.org/10.5772/intechopen.86652

selective serotonin reuptake inhibitors [22].

include smoking and psychological stress [30].

and mucosal blood flow.

NSAIDs.

3.1 Clinical features

5

gastric and duodenal tuberculosis, and syphilis can mimic PUD.
