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Peptic ulcer disease usually refers to the digestive ulcer of in the stomach, duodenum or the mucosa of the two surfaces. However ulcer can occur to any area exposed to adequate concentration or time of acid or gastrointestinal tract under pepsin.

Cause of Diseases

• Helicobacter pylori infection: H. pylori is gram-negative bacteria with 3 pairs of flagellum and exists on gastric mucus. Contact infection could be the main spread of helicobacter pylori, including water, food, teeth, and saliva can all become paths of infection.
• Currently the infection of the bacteria has a correlation with gastric ulcer approximately 60-70% and a correlation with duodenal ulcer approximately 90-95%.
• Medicine: Common medicines causing ulcer include NSAIDs, aspirin, COX2, and warfarin.
• Stress: Such as trauma, brain injury, burns, acute pancreatitis, and others often cause stress-based ulcer.
• Endocrine disease: i.e. gastrinoma is caused by excess secretion of gastric acid.
• Smoking: Also an important risk factor.
• Weather: Peptic ulcers often occur during change of climate. 
• Others: Drinking, emotion, and genetic inheritance.  

Clinical Manifestations

• Most common symptoms include upper abdominal pain or fullness, sometimes companied by nausea, vomiting, and even gastrointestinal bleeding and weight loss. Sometimes the symptoms could be non-particular symptoms such as dyspepsia, abdominal bloat, and poor appetite.
• The gastric ulcer is deviated towards post-meal pain while duodenal ulcer is hungry-based pain or midnight pain; sometimes the pain can radiate to the back and is related to some ulcer on the duodenal bulb of duodenum. Some patients show interval and seasonal rules in the manifestation of pain. 

Diagnosis 

• Physical examination: Often expressed in upper abdominal pain but also could be normal.
• Laboratory Examination: No special exam shall be conducted on patients without symptoms but if bleeding occurs, patients must be examined for blood, electrolyte, and stool occult blood reaction.
• Radiology
• Upper GI Barium Series: Commonly used to diagnose peptic ulcer in the past and is now rarely used.
• Upper GI Endoscopy (commonly known as esophaegogastroduodenoscope): is the currently diagnosis tool mostly used. Apart from applying to diagnosis, the endoscopy can also be performed for hemostasis and biopsy as well as other technology. About 7% of gastric ulcer is malignant tumor and hence must undergo biopsy examination on the edge of ulcer, which shall be followed up for examination through gastroscopy after treatment. If the healing fails, patients will need to take another biopsy examination.
• Helicobacter pylori: The diagnosis practice can be divided into invasive and non-invasive types. Invasive type includes biopsy examination, tissue bacteria DNA test, and rapid urease test for tissues (CLO test); non-invasive type includes C13 breath test, antigen test in blood helicobacter pylori, and antigen test for stool helicobacter pylori.  

Principles of Treatment

• Corrective risk factors: Including smoke and alcohol cessation, or suspension of pain relief, coagulant, or use of steroid medicine.
• Food: Reduce consumption of spicy food.
• Medicine: If peptic ulcer is complicated with acute bleeding, patients should go into fasting and used PPI in order to inhibit the secretion of gastric acid.
• Once the bleeding stops and patients start eating, change the aforementioned medicine to oral agents. If the patients do not have complications in upper gastrointestinal bleeding, provide the aforementioned oral medicines to the patients directly. Gastric ulcer usually takes 6-8 week of therapy while the general treatment for duodenal ulcer takes 4-6 weeks.
• Sterilization: If peptic ulcer is complicated with helicobacter pylori infection, apply eradication therapy to reduce the recurrence rate of ulcer.
• Common therapies include Triple Therapy for a period of 1-2 weeks. If treatment fails, patients can consider taking Quadruple Therapy for other formula.
• Reference: Gastric Ulcer and Triple Therapy or Quadruple Therapy
• Surgery: Due to the continuous advancement in aforementioned safety and effective medicine, the role of surgery is gradually on the decline. Hence, the indications for current surgeries include the peptic ulcer complications with bleeding that could not be stopped by endoscopic treatment, or complications in gastric perforation and complications in gastric outlet obstruction that could not be treated by endoscopy.