Peptic ulcer disease is a condition about stomach lining destruction which is usually being initiated by gastric acid and pepsin. In this condition abrasion of mucosa occurs that would continue until the submission of the submucosa. People who have ulcers in their abdomen can feel the pain in epigastric region during the food intake. 

The epidemiological data on lifetime development risk is estimated in between 5 to 10 %. The incidence is declined globally due to sanitary and hygienic conditions & cautious NSAID usage across the globe. 

The most common reason for developing a peptic ulcer is a H. pylori infection that trigger inflammation as well as ulcer formation in the stomach lining. Peptic ulcers come about because of a mucosal integrity offensive (gastric acids) versus the imbalance. 
Prostaglandins inhibit the gastric mucosal cells from growing back and NSAIDs lead to their depletion. This in turn reduces the protective oils. Smoking leads to decrease in the blood flow mucosal which in turn is very harmful for mucosal healing. Ulcers can be further aggravated by conditions as Zollinger-Ellison syndrome, where it can induce a dysfunction of the hormones responsible to produce stomach acid or an excess of this acid. 
On the other hand stress can magnify symptoms but in the ulcer development it has a minor role following the two causes of infection H. pylori and NSAID usage. 

Helicobacter pylori infection leads to inflammation that gradually results in an ulcer. This bacterium break down the protective-mucous sheath of the stomach and duodenum, aiding the acid attack on the adjacent tissues. 
On the other hand, extended use of NSAIDs can magnify the risks of getting ulcers. These medicines are known to cause irritation of the stomach lining and reduce its ability to withstand acid exposure, hence the incidence of acid exposure. Smoking also leads to some increased risks of peptic ulcers which might worsen the healing process of current ulcers and therefore raise the probability of their recurrence. 
Whereas, like this, strong alcohol drinking will make worse the diseases as it can cause inflammation to the stomach lining which in turn increases acid making bad ulcer diseases. 
The same is also applicable for family history of peptic ulcers some people are more susceptible to developing them and medical complications related to genetic predisposition is still poorly understood. 

When the condition is appropriately managed, the disease is usually favourable. 

The recurrence of the disease is avoided by smoking, alcohol, & NSAID’s. 

 Young Adults (18–40 years old): Helicobacter pylori infection and nonsteroidal anti-inflammatory medication (NSAID) usage are frequently linked to peptic ulcer disease in this age range. One or more symptoms might be sporadic, scorching, or gnawing stomach discomfort that goes away with meals or antacids. Additionally, dyspepsia symptoms including belching, bloating, and early satiety may be present.  
Middle-aged Adults (40–60 years): This age group may have symptoms that are comparable to those of young adults, but because of their longer illness duration and perhaps higher NSAID usage, they are more prone to experience consequences including bleeding or perforation.  

Abdominal Examination 

Vital Signs 

Gastrointestinal examination 

Systemic examination 

Digital Rectal Examination  

General Examination 

The comorbidity comprises risk factors for the individuals who is involved in smoking alcohol intake and regular NSAID’s use and stress. 

The presentation is divided in 2 types. 

The acute presentation and the chronic presentation. 

These can be distinguished based on the symptoms like heart burn and dyspepsia are common in chronic & perforation and bleeding are common in acute. 

Lifestyle modifications: Avoid spicy, acidic and caffeinated foods. Just for the process of healing to be successful, stop smoking a cigarette to improve your gastrointestinal health. Limit the consumption of alcohol. 

Medications: The medications which are prescribed in the treatment includes PPI’S, H2 receptor antagonists and cytoprotective agents. 

Gastroenterology

Lifestyle Modifications: 

Dietary changes:
Talking about eating balanced meals at regular intervals and fasting over the long-term will may sedated stomach and troubles with the digestion.

Stress Management: Provide a few techniques of relaxation such as deep breathing, meditation, and yoga to help handle stress being the major provoker of ulcers. Administration to psychological support to counsel the patients who may disrupt the severe stress and anxiety.

Smoking Cessation: Guide patients to stop smoking to have the ulcer healing and recover from it more effectively.

Weight Management: Develop healthy weight maintenance efforts around exercising and right eating habits.

Physical Activity: Urge physical activity including walking, jogging, yoga, etc as a form of treatment to improve your colon health and general health.

Avoiding NSAIDs: Warning or suggestion against and/or prohibit of NSAIDs as they can increase the risk of ulcer development. 

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Sucralfate: It’s a complex of sucrose sulfate and aluminum hydroxide, forming a protective barrier over ulcers, promoting mucosal defense by stimulating mucus and bicarbonate production, and indirectly aiding ulcer healing by enhancing prostaglandin synthesis. 

Gastroenterology

Omeprazole: Omeprazole effectively treats ulcers, GERD, and conditions with excess acid. Usual dose: 20-40 mg once daily before a meal. 

Lansoprazole: Lansoprazole, like omeprazole, reduces gastric acid secretion. It’s used for GERD and excess acid conditions. Typical dose: 15-30 mg once daily before a meal. 

Gastroenterology

Famotidine: Famotidine provides agonists of acid during ulcer healing as well as an additional defense against the formation of new ulcers. 
 
Ranitidine: The H2 blocker ranitidine which is used to cure ulcers by preventing histamine’s effect on stomach H2 receptors, also works for GERD and high acid in the stomach of Zollinger-Ellison disease. 

Gastroenterology

Surgery:  

Ulcer Resection: Surgically remove ulcers, especially for stubborn ones or those with complications like perforation, obstruction, or cancer. 

Vagotomy: Cut the vagus nerve to reduce stomach acid, often done with pyloroplasty to treat severe or recurring ulcers. 

Gastric Bypass: Redirect food away from affected stomach or duodenal areas in cases of complicated ulcers with bleeding or obstruction. 

Gastroenterology

Diagnosis involves patient history, symptoms, and tests like endoscopy or Helicobacter pylori testing. 

Immediate relief with medications like PPIs or H2 blockers. 

Antibiotics used if Helicobacter pylori infection confirmed. 

Healing phase includes continued medication and lifestyle changes. 

Maintenance phase may involve long-term medication and H. pylori monitoring. 

Preventive measures focus on H. pylori eradication and lifestyle modifications. 

Complications managed with immediate interventions like endoscopic hemostasis or surgery.