A peptic ulcer, also known as PUD or peptic ulcer disease, is an ulcer (defined as mucosal erosions equal to or greater than 0.5 cm) of an area of the gastrointestinal tract that is usually acidic and thus extremely painful.
As many as 70-90% of ulcers are associated with ''Helicobacter pylori'', a spiral-shaped bacterium that lives in the acidic environment of the stomach; however, only 40% of those cases go to a doctor.
Ulcers can also be caused or worsened by drugs such as aspirin and other NSAIDs.
Contrary to general belief, more peptic ulcers arise in the duodenum (first part of the small intestine, just after the stomach) rather than in the stomach.
About 4% of stomach ulcers are caused by a malignant tumor, so multiple biopsies are needed to exclude cancer. Duodenal ulcers are generally benign.
The lifetime risk for developing a peptic ulcer is approximately 10%.
In Western countries the prevalence of Helicobacter pylori infections roughly matches age (i.e., 20% at age 20, 30% at age 30, 80% at age 80 etc.).
Prevalence is higher in third world countries. Transmission is by food, contaminated groundwater, and through human saliva (such as from kissing or sharing food utensils.)
A minority of cases of Helicobacter infection will eventually lead to an ulcer and a larger proportion of people will get non-specific discomfort, abdominal pain or gastritis.
Peptic ulcer disease had a tremendous effect on morbidity and mortality until the last decades of the 20th century, when epidemiological trends started to point to an impressive fall in its incidence.
The reason why the rates of peptic ulcer disease decreased is thought to be the development of new effective medication and acid suppressants and the discovery of the cause of the condition, H. pylori.
In the United States about 4 million people have active peptic ulcers and about 350,000 new cases are diagnosed each year.
Four times as many duodenal ulcers as gastric ulcers are diagnosed.
Approximately 3,000 deaths per year in the United States are due to duodenal ulcer and 3,000 to gastric ulcer.
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