Peptic ulcer disease

Lancet. 2009 Oct 24;374(9699):1449-61. doi: 10.1016/S0140-6736(09)60938-7. Epub 2009 Aug 13.


Peptic ulcer disease had a tremendous effect on morbidity and mortality until the last decades of the 20th century, when epidemiological trends started to point to an impressive fall in its incidence. Two important developments are associated with the decrease in rates of peptic ulcer disease: the discovery of effective and potent acid suppressants, and of Helicobacter pylori. With the discovery of H pylori infection, the causes, pathogenesis, and treatment of peptic ulcer disease have been rewritten. We focus on this revolution of understanding and management of peptic ulcer disease over the past 25 years. Despite substantial advances, this disease remains an important clinical problem, largely because of the increasingly widespread use of non-steroidal anti-inflammatory drugs (NSAIDs) and low-dose aspirin. We discuss the role of these agents in the causes of ulcer disease and therapeutic and preventive strategies for drug-induced ulcers. The rare but increasingly problematic H pylori-negative NSAID-negative ulcer is also examined.

Publication types

  • Review

MeSH terms

  • Antacids / therapeutic use
  • Anti-Inflammatory Agents, Non-Steroidal / adverse effects
  • Anti-Ulcer Agents / therapeutic use
  • Aspirin / adverse effects
  • Biopsy
  • Gastroscopy
  • Global Health
  • Helicobacter Infections / complications
  • Helicobacter pylori
  • Histamine H2 Antagonists / therapeutic use
  • Humans
  • Incidence
  • Morbidity
  • Organometallic Compounds / therapeutic use
  • Peptic Ulcer* / diagnosis
  • Peptic Ulcer* / epidemiology
  • Peptic Ulcer* / etiology
  • Peptic Ulcer* / therapy
  • Prostaglandins, Synthetic / therapeutic use
  • Proton Pump Inhibitors / therapeutic use
  • Risk Factors
  • Severity of Illness Index


  • Antacids
  • Anti-Inflammatory Agents, Non-Steroidal
  • Anti-Ulcer Agents
  • Histamine H2 Antagonists
  • Organometallic Compounds
  • Prostaglandins, Synthetic
  • Proton Pump Inhibitors
  • bismuth tripotassium dicitrate
  • Aspirin