Peptic ulcer and dyspepsia

Peptic ulcers are defects in the gastrointestinal mucosa that extend through the muscularis mucosae. They persist as a function of the acid or peptic activity in gastric juice. Twenty years ago, most ulcers were considered idiopathic; but a revolution in knowledge has occurred, so that it is now understood that the great majority of ulcers results from infection with Helicobacter pylori (HP) or use of nonsteroidal anti-inflammatory drugs (NSAIDs). Before this revolution, peptic ulcer disease was a common public health problem, responsible for considerable morbidity, some mortality, and high economic cost. Today, the overall prevalence of ulcers is falling, but complication rates remain relatively stable. These complex trends primarily reflect 3 factors: the rapid decline in the prevalence of HP in the population of developed countries, an increase in consumption of NSAIDs, and change in rates of smoking. Peptic ulcer prevalence is falling in younger individuals because of decreased prevalence of HP, whereas complications are rising in older subjects, largely as the result of increased NSAID use.