Complications of peptic ulcers

Abstract Peptic ulcer disease, defined as the breakdown of the epithelial mucosal barrier of the stomach and/or duodenum, remains a cause of significant morbidity and mortality. Major aetiological factors include Helicobacter pylori infection and non-steroidal anti-inflammatory drug use. Epigastric pain, heartburn, reflux symptoms and nausea are common in patients with peptic ulceration. The diagnosis is most often established following upper gastrointestinal endoscopy. The introduction of acid-reducing pharmacological agents and H. pylori eradication regimes are the mainstay of current treatment. Surgical management is generally reserved for the management of the complications of peptic ulcer disease, such as acute haemorrhage, intestinal perforation and gastric outflow obstruction. Surgery in these circumstances is often challenging and may require a high level in expertise. This review will discuss the main aetiological agents involved in the development of peptic ulcer disease and describe the underlying pathogenesis. The diagnosis and management of uncomplicated peptic ulcer disease will then be outlined. Finally, the management of peptic ulcer complications will be detailed, with particular reference to the surgical aspects of care.