Peptic Ulcer: Chapter Closed?

Area of Science:

• Gastroenterology
• Internal Medicine
• Epidemiology

Background:

• Peptic ulcer disease (PUD) incidence peaked in the late 19th/early 20th century, declining significantly in the 21st century.
• Demographic shifts, including an aging population with comorbidities and polypharmacy, contribute to persistent PUD complications.
• The historical acid-suppression model for PUD management has been largely superseded by the understanding of Helicobacter pylori's role.

Purpose of the Study:

• To review the evolving landscape of peptic ulcer disease.
• To highlight the impact of Helicobacter pylori and emerging antibiotic resistance.
• To discuss current challenges in PUD etiology identification and management.

Main Methods:

• Literature review of PUD incidence, etiologies, and treatment modalities.
• Analysis of demographic trends influencing PUD complications.
• Discussion of therapeutic advancements and challenges, including H. pylori eradication and antibiotic resistance.

Main Results:

• Proton pump inhibitors rapidly resolve symptoms but do not cure PUD.
• Helicobacter pylori eradication has transformed PUD into a curable disease.
• Increasing antibiotic resistance in H. pylori leads to treatment failures.
• Non-H. pylori etiologies are becoming more prevalent, necessitating accurate diagnosis.

Conclusions:

• Peptic ulcer disease management requires identifying the specific ulcerogenic cause for tailored therapy.
• Effective management of peptic ulcer bleeding remains a significant clinical challenge.
• While PUD has become more heterogeneous, its study and treatment are ongoing.