Comprehensive Wellness Guide to Understanding and Managing Peptic Ulcer Disease

PUD: 4M US cases/yr; 10% lifetime risk. H. pylori eradication → 95% healing. PPI 8 wks: ulcer ↓ 80%. In Peptic Ulcer Disease 101, we explore CLO test, Forrest classification, and holistic strategies for acid control, bleeding prevention, and gastric healing in 2025. This guide empowers patients, gastroenterologists, and dietitians with science-backed tools to soothe the stomach and prevent complications.

What Is Peptic Ulcer Disease?

Mucosal break >5 mm in stomach/duodenum. 70% H. pylori, 20% NSAID.

Introduction: Why PUD Matters

Bleeding 15%, perforation 2%, mortality 5%. Vonoprazan → 30% faster healing. In 2025, AI endoscopy, breath tests, and low-acid diets redefine care. This guide offers strategies to eradicate, protect, and heal.

Types of Peptic Ulcers

Location + etiology:

• Gastric: Body/antrum, NSAID/H. pylori.
• Duodenal: Bulb, H. pylori 90%.
• Stress: ICU, Cushing/Curling.
• Zollinger-Ellison: Gastrinoma, multiple.

Causes and Risk Factors of Peptic Ulcer

Acid + insult:

• H. pylori: 70% (cagA+ RR 3).
• NSAIDs: 20% (COX-1).
• Smoking: RR 2.
• Stress, alcohol, steroids.

Peptic Ulcer Symptoms to Watch For

Classic + alarms:

• Epigastric pain: Duodenal post-meal relief, gastric worsens.
• Bleeding: Melena, hematemesis.
• Red flags: Weight loss, dysphagia, anemia.
• Complications: GOO, perforation.

Diagnosis of Peptic Ulcer

EGD gold standard; non-invasive first.

• EGD: Biopsy CLO + histology.
• Urea breath/stool Ag: 95% sens.
• Serology: Past infection.
• Forrest: Ia (spurting) → endo Rx.

Forrest	Risk Rebleed	Action
Ia	90%	Clip/inject
IIb	25%	Coagulate
III	5%	PPI only

Treatment Options for Peptic Ulcer

ACG 2024: Eradicate + protect.

H. pylori

• Triple: PPI-clarithro-amox 14 d.
• Bismuth quad: PPI-BMT 14 d (resistance).
• Vonoprazan: P-C-A 7–14 d.

Acid suppression

• PPI 40 mg BID × 4–8 wks.
• Sucralfate 1 g QID.

Bleeding

• Endo hemostasis, IV PPI 72 h.
• Angio/surgery if fail.

Actionable Tip: NSAID stop + PPI → healing 95%.

Management Routine for Peptic Ulcer

8 wk + long-term protocol:

1. Day 1: EGD, CLO, PPI BID.
2. Week 2: Start eradication.
3. Week 8: Confirm healing, breath test.
4. Month 3: NSAID alternative, diet.
5. Yearly: High-risk re-scope.

Management Tips

• Low-acid: Avoid spice, caffeine, alcohol.
• Stress: Yoga, CBT.
• App: UlcerEase, food log.
• Support: ACG forums.

Step	Action	Duration
PPI	40 mg BID	4–8 wks
Eradication	Bismuth quad	14 d
Follow-up	Breath test	4 wks post

Lifestyle Changes to Support Gastric Healing

Protect mucosa:

1. Diet

• Bland, small meals, banana, cabbage juice.

2. Habits

• No smoking, alcohol, NSAIDs.

3. Stress

• Mindfulness, sleep 7–9 h.

4. Weight

• BMI <25 → reflux ↓.

Actionable Tip: 3 mo abstinence → recurrence <5%.

Emotional and Mental Wellness

Chronic pain → anxiety. Support with:

• Counseling: Pain coping.
• Support: PUD groups.
• Hope: 95% heal with Rx.
• Advocacy: World Digestive Health Day.

Preventing Peptic Ulcer Recurrence

Target cause:

• H. pylori: Confirm eradication.
• NSAID: COX-2 or PPI co-Rx.
• Stress: Prophylactic PPI ICU.
• ZES: High-dose PPI, octreotide.

When to See a Doctor

Urgent if:

• Black stool, vomiting blood.
• Severe epigastric pain + rigidity.
• NSAID use + pain >2 wks.
• Weight loss, anemia.

Gastro → EGD, PPI, test-and-treat.

Myths About Peptic Ulcer

Debunking myths saves lives:

• Myth: Spicy food causes. Aggravates, not causes.
• Myth: Milk heals. Rebound acid.
• Myth: Stress only. H. pylori/NSAID main.
• Myth: Benign. 15% bleed.

Holistic Approach to Gastric Care

Integrate eradicate, suppress, protect:

• Personalize: Risk, resistance, PPI metabolism.
• Tech: AI endoscopy, capsule pH, breath AI.
• Team: Gastro, RD, psych, pharmacist.
• Future: H. pylori vaccine, mucosal bio-gel.

Conclusion

Peptic ulcers are curable with modern therapy. Eradicate H. pylori, suppress acid, and change habits to heal fully. In 2025, gastric health is proactive—test, treat, protect. Your stomach deserves peace.