Muhammad Umer Faheem


Peptic ulcer disease is a problem of the gastrointestinal tract characterized by mucosal damage secondary to pepsin and gastric acid secretion. Typical symptoms of peptic ulcer disease include history of episodic or epigastric pain, relief of pain after food intake, and night-time awakening because of pain with relief following food intake. Until relatively recently, most ulcers were considered ‘idiopathic’. However, in 1983, association between peptic ulcers and Helicobacter pylori (H. pylori) infection was demonstrated.  The complex and multifactorial pathogenesis of peptic ulcer has been studied over several decades, and results from an imbalance of aggressive gastric luminal factors acid and pepsin and defensive mucosal barrier function. Among environmental factors, smoking, excessive alcohol use, and drug use are most often quoted but none of them, apart from NSAID use, were identified as an individual ulcerogenic agent. There appear to be a true subset of patients who do not have H. pylori infection, have not been exposed to NSAIDs, and after appropriate testing have unexplained peptic ulceration. These patients can be referred to as having idiopathic ulcer disease. The prevalence of idiopathic ulcers appears to be increasing, and in some studies, it accounts for up to 50% of peptic ulcers. There is some evidence to suggest that genetic factors play an important role in the aetiology of peptic ulcer disease. Blood group O and non-secretor status are genetic traits associated with duodenal ulcer disease, and when both are present, they increase the risk of the disease by 150%. The long-term management of unexplained chronic duodenal and gastric ulcer disease remains ill defined. Antisecretory drugs remain the mainstay of treatment for promoting healing of idiopathic peptic ulceration. H. pylori and NSAIDs remain important causes of peptic ulcer, but the epidemiology is changing. It is unclear whether there is, in fact, a real increase in non-H. pylori/NSAID-negative ulcers occurring, or whether this is just a change in proportion caused by the disappearance of the infection because of a cohort effect.

Keywords: Idiopathic peptic ulcer disease, H. pylori, NSAID, 

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