A Surgical Perspective on Peptic Ulcer Disease
Keywords: Complications, duodenum, helicobacter pylori, NSAIDs, peptic ulcer disease, stomach, surgical management Hemorrhage, Perforation, Gastric outlet obstruction
Asadullah Hussainzai
Abstract
Peptic ulcer disease (PUD) is a common and significant gastrointestinal disorder characterized by mucosal erosion and ulceration in the stomach and duodenum. Its development is multifactorial, with Helicobacter pylori infection, prolonged use of non-steroidal anti-inflammatory drugs (NSAIDs), increased gastric acid secretion, and lifestyle factors being major contributors. Although most cases can be effectively managed with medical therapy, including proton pump inhibitors (PPIs) and H. pylori eradication protocols, some patients require surgical intervention due to complications. From a surgical perspective, PUD is considered serious when it is resistant to medical therapy or associated with life-threatening complications. Bleeding, perforation, and gastric outlet obstruction are key complications that may necessitate urgent or elective surgical procedures. This study provides a comprehensive review of the surgical aspects of PUD, including anatomy, physiology, pathophysiology, clinical manifestations, diagnostic approaches, medical management, and elective and emergency surgical interventions. The review also highlights the risks associated with NSAID use in H. pylori-positive patients and strategies to prevent ulcer recurrence. Overall, while medical therapy has reduced the need for surgery, surgical knowledge and expertise remain essential for the management of complicated cases. Integrating evidence-based medical and surgical approaches is critical to improving patient outcomes and reducing morbidity associated with PUD.
