Emergent Care / Stabilization:
Complications of peptic ulcer disease such as ulcer rupture, gastric outlet obstruction, acute gastrointestinal (GI) hemorrhage, and sepsis require immediate action. Abnormal vital signs or peritoneal signs on examination should raise concern for a possible surgical emergency. Resuscitative measures, including IV access, broad-spectrum antibiotics, and emergent imaging, should be obtained.

Diagnosis Overview:
Peptic ulcer disease (PUD) refers to the formation of ulcers in the gastric or duodenal mucosa due to an imbalance of acid production and mucosal barrier defense mechanisms. Historically, up to 80% of peptic ulcers were caused by Helicobacter pylori infection. However, the rate of H pylori infection has significantly declined in the United States, although Eastern Asian and Hispanic populations, as well as patients who have recently immigrated from developing countries, are at higher risk than the general population.

The two most common causes of PUD are NSAID use (including aspirin) and H pylori infection. PUD is less common in pediatric populations, and the risk of GI bleeding in children is even lower. There is a higher incidence of PUD in males and individuals who use tobacco. Additionally, prolonged steroid use, excessive alcohol use, physiologic stress such as burns or prolonged intubation, and rare conditions such as Zollinger-Ellison syndrome can cause PUD.

Up to two-thirds of patients with PUD are asymptomatic. Patients with PUD may present with epigastric pain, dyspepsia, bloating, abdominal fullness, nausea, and early satiety. The most concerning complications of PUD include acute bleeding and perforation due to ulcer erosion through the mucosal wall. These complications require endoscopic or surgical intervention.