Peptic ulcer and other benign gastro-duodenal diseases

1. Big picture

Peptic ulcer disease is now mainly a medical disease, but it becomes a surgical disease when it causes:

Bleeding → Perforation → Penetration → Gastric outlet obstruction

For the surgery final exam, the key is not only “what causes ulcers,” but when a patient needs urgent endoscopy, interventional radiology, or emergency operation.

The classic surgical emergency is:

Sudden severe epigastric pain + board-like abdomen + free air under diaphragm
= perforated peptic ulcer until proven otherwise

The most common causes are Helicobacter pylori infection and non-steroidal anti-inflammatory drug use (NSAIDs). Although uncomplicated ulcer disease has decreased with proton pump inhibitors and H. pylori eradication, complicated disease remains important: WSES guidelines state that peptic ulcer disease has a lifetime prevalence of about 5–10%, complications occur in 10–20%, and perforation is the most common indication for emergency operation in ulcer disease. ([SpringerLink][1])

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