Peptic ulcer natural history

Helicobacter pylori infection is a common cause of peptic ulcer disease which is acquired usually during childhood but presents in second to fifth decade of life. Patient presents with episodic epigastric pain, indigestion, bloating,hematemesis and melena. If not treated, patients can develop complications like bleeding, perforation, obstruction or stricture. Chronic infection of helicobacter pylori leads to gastric cancer, MALT lymphoma, iron deficiency anemia, Idiopathic thrombocytopenic purpura. Peptic ulcers tend to recur if left untreated. Prognosis is good if the eradication therapy of Helicobacter pylori is taken.The recurrence rate of patients with peptic ulcer disease is less than 20%.

• The infection of Helicobacter pylori , common cause of peptic ulcer disease is acquired usually during the childhood, mainly in those who have low socioeconomic status, increased number of siblings and similar infection in the mother.^[1][2][3]
• The duodenal ulcer occurs in second to fifth decade of life. where as gastric ulcer occurs in the 4th decade of life.
• Peptic ulcer disease starts with symptoms such as episodic epigastric pain, indigestion, bloating.
• Without treatment, the patient will develop symptoms of perforation like severe abdominal pain. Chronic infection leads to gastric atrophy, gastric metaplasia and ultimately leads to gastric cancer and MALT lymphoma.^[4]

• Bleeding is the commonest complication.
  • Sudden large bleeding can be life threatening.
  • Bleeding occurs when the ulcer erodes one of the blood vessels around the stomach.^[5][6]
• Perforation
  • Perforation is most common occur at the duodenal bulb (62%), followed by the pyloric region (20%), and the gastric body (18%).
  • Erosion of the gastro-intestinal wall by the ulcer leads to spillage of stomach or intestinal content into abdominal cavity leading to fatal consequences.
  • Perforation at the anterior surface of stomach leads to acute peritonitis, initially chemical and later bacterial peritonitis.
  • Often, the first symptom is a sudden intense abdominal pain.
  • Posterior wall perforation leads to pancreatitis, pain in this situation often radiates to back.
  • Penetration is also a form of perforation, when the ulcer continues into adjacent organs such as liver and pancreas.^[7][8]
• Obstruction
  • Occurs as a result of stricture and scarring narrowing in the duodenum leading to gastric outlet obstruction.

Chronic Helicobacter pylori infection leads to:

• Gastric cancer
• MALT lymphoma
• Iron deficiency anemia
• Idiopathic thrombocytopenic purpura

• Prognosis is good if the eradication therapy of Helicobacter pylori is taken.
• The recurrence rate of patients with peptic ulcer disease is less than 20%.

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