Chapter 44
Peptic Ulcer Disease and GERD
Acid, ulcers, and reflux
PUD, GERD & Dyspepsia — Defined
Peptic ulcer disease (PUD) is a group of disorders with circumscribed lesions of the upper GI mucosa (stomach and duodenum) in regions exposed to gastric juices. Gastroesophageal reflux disease (GERD) is retrograde movement of gastric contents into the esophagus; when reflux causes esophageal inflammation it is reflux (erosive) esophagitis, but 50-70% of patients have typical symptoms without mucosal injury (nonerosive reflux disease, NERD). Dyspepsia is persistent or recurrent upper-abdominal pain or discomfort.
Three related acid disorders. PUD = ulcers in the stomach/duodenum. GERD = acid refluxing up into the esophagus (often without visible erosions = NERD). Dyspepsia = a symptom (upper-abdominal pain) that can come from PUD, GERD, cancer, or have no organic cause ('functional' dyspepsia). Nearly 80% of peptic ulcers are duodenal.
Most Ulcers Are Duodenal
About 80% of peptic ulcers are DUODENAL and nearly all are benign; only up to 10% of GASTRIC ulcers are malignant — which is why a gastric ulcer needs biopsy and follow-up to confirm healing. Duodenal ulcers strike ages 20-50; gastric ulcers ages 45-55.
📖 “PUD: upper-GI mucosal lesions (stomach/duodenum). GERD: retrograde gastric contents into esophagus; erosive esophagitis vs NERD (50-70%). Dyspepsia: recurrent upper-abdominal pain. 80% of ulcers duodenal.”