Peptic Ulcer Disease

Peptic Ulcer Disease (PUD) it is a very prevalent condition, because it affects around 5-10% of the general population worldwide, but with no table regional and racial variations. The two most common etiological causes are the chronic infection with Helicobacter Pylori (Hp) and the use of Non-Steroidal Anti- Inflammatory Drugs (NSAIDs). Its diagnosis is based mainly in the endoscopy and the active search of concomitant Hp presence. The discovery of the link between H. pylori and peptic ulcer has changed dramatically its management, because it has become a curable infectious disease. The eradication treatment of Hp (+) is the best choice for achieve the final cure of the PUD in infected patients. Several current international guidelines recommend a standard triple therapy as first-line therapy, including a proton pump inhibitor and a combination of amoxicillin and clarithromycin. This combination therapy has shown a decreasing efficacy over the years. The main reason is the increasing antibiotic resistance, particularly to clarithromycin and metronidazol, of certain Hp strains. Several new treatment options or modifications of already established regimens have been introduced in last year’s, to overcome these treatment failures. For the subgroup of patients with H. pylori-negative ulcers, NSAIDs stop intake also has a clear influence in the evolution of the disease and in some cases drives to the complete healing of the peptic ulcer. In refractory or recurrent cases, continuous therapy with anti-secretory agents and/or the replacement of conventional NSAIDs by selective drugs for inhibition of Cyclooxygenase-2 (COX-2) are useful treatment options.