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Background Peptic ulcer disease (PUD) is a common digestive disorder, of which the prevalence decreased in the past few decades. However, the decreasing tendency has plateaued in recent years due to changes in risk factors associated with the etiology of PUD, such as non-steroidal anti-inflammatory drug use. In this study, we investigated the epidemiological and the sociodemographic characteristics of PUD in 204 countries and territories from 1990 to 2019 based on data from the Global Burden of Disease, Injuries and Risk Factors (GBD) Study. Methods Demographic characteristics and annual prevalence, incidence, mortality, disability-adjusted life years (DALYs) and age-standardized death rate (ASR) data associated with PUD were obtained and analyzed. According to the sociodemographic index (SDI), the numbers of patients, ASRs, estimated annual percentage changes and geographical distributions were assessed with a generalized linear model and presented in world maps. All evaluations of numbers and rates were calculated per 100,000 population with 95% uncertainty intervals (UIs). Results In 2019, the global prevalence of PUD was approximately 8.09 [95% UI 6.79–9.58] million, representing a 25.82% increase from 1990. The age-standardized prevalence rate was 99.40 (83.86–117.55) per 100,000 population in 2019, representing a decrease of 143.37 (120.54–170.25) per 100,000 population from 1990. The age-standardized DALY rate in 2019 was decreased by 60.64% [74.40 (68.96–81.95) per 100,000 population] compared to that in 1990. In both sexes, the numbers and ASRs of the prevalence, incidence, deaths and DALYs were higher in males than in females over 29 years. Regionally, South Asia had the highest age-standardized prevalence rate [156.62 (130.58–187.05) per 100,000 population] in 2019. A low age-standardized death rate was found in the high-income super-region. Among nations, Kiribati had the highest age-standardized prevalence rate [330.32 (286.98–379.81) per 100,000 population]. Regarding socioeconomic status, positive associations between the age-standardized prevalence, incidence, death rate, DALYs and SDI were observed globally in 2019. Conclusions Morbidity and mortality due to PUD decreased significantly from 1990 to 2019, while a gradual upward inclination has been observed in recent 15 years, which might be associated with changes in risk factors for PUD. Attention and efforts by healthcare administrators and society are needed for PUD prevention and control.

Background and Aims: Acute upper gastrointestinal (UGI) bleed is an emergency requiring immediate intervention. Recent data have shown peptic ulcer disease (PUD) to be commonest cause of UGI bleed. We aimed to evaluate all patients of UGI bleed reporting in emergency department. Methods: A cross-sectional, observational study from a tertiary care centre and evaluated all patients with UGI bleed presenting to outpatient and emergency department between December 2017 and December 2018 conducted. Results: 356 patients with UGI bleed were undertaken for diagnostic and therapeutic endoscopy. Variceal bleed was present in 231 (65%) [cirrhosis 217(61%) vs non-cirrhotic 14 (4%)], non-variceal 93 (26%) [cirrhosis 22(6%) vs non-cirrhotic 71(20%)] and no cause determined in 32 (9%). Among cirrhotic patients, alcoholic liver disease (n=172) was most common followed by cryptogenic (n=32), HCV (n=22) and HBV (n=7) and AIH (n=6) related cirrhosis. Among variceal non-cirrhotic causes, non-cirrhotic portal hypertension was present in 14 patients. In non-cirrhotic non-variceal group, causes of UGI bleed included esophagitis (n=26), erosive gastritis (n=9) and Mallory Weiss Tear (n=7) followed by PUD (n=23), carcinoma stomach (n=3), carcinoma esophagus (n=2) and duodenal polyp (n=1). Non-variceal cirrhotic patients had portal hypertensive gastropathy (n=8), PUD (n=5), duodenal erosions (n=1), esophagitis (n=7), antral varix (n=1). Interestingly, even in non-variceal group, alcohol was the underlying cause of UGI bleed in majority of patients with esophagitis and erosive gastritis. Conclusion: Alcohol was the commonest cause of UGI bleed in majority of cases with or without chronic liver disease followed by PUD in small number in emergency department.

Background Perforated peptic ulcers (PPU) represent a significant complication of peptic ulcers, associated with high mortality. As no systematic review of the literature on PPU in children currently exists, this study aims to summarize findings from studies focusing on its risk factors, etiology, treatment modalities, and outcomes. Methods A systematic review was conducted following the PRISMA guidelines. A literature search was performed on 24 November 2024, using four electronic databases: Web of Science, Scopus, PubMed, and ScienceDirect. The inclusion criteria were studies published in English, focusing on perforated peptic ulcers in paediatric patients. The exclusion criteria were: studies published in languages other than English; publication formats such as conference abstracts, personal communications, and single case reports; studies focusing on non-perforated peptic ulcers; studies involving participants > 18 years; and studies reporting ulcer perforations outside the stomach or duodenum. Results Out of 1963 records identified, 12 studies met the inclusion criteria and were included in the review. A total of 239 children with perforated peptic ulcers were analyzed, with a median age of 11 years (range 3.2–16.5 years). The results indicate that ulcer perforations were more prevalent in males (74.8%). Furthermore, duodenal perforations (73%) were more common than gastric perforations (27%). The most commonly reported symptoms were abdominal pain ( n  = 175, 73.2%), vomiting ( n  = 82, 34.3%), peritoneal signs ( n  = 79, 33%), and fever ( n  = 38, 15.9%). Subdiaphragmatic free air was detected in 141 patients (58.9%). Of the total number of patients, 207 (86.6%) were treated surgically, while 32 (13.4%) received conservative treatment. Regarding the surgical approach, most patients underwent open surgery ( n  = 143, 69%) compared to laparoscopic repair ( n  = 64, 31%). Among the surgical procedures, 114 involved simple sutures, with or without an omental patch. Postoperative complications were reported in 30 children (14.5%). Reoperation was required in 4 patients (1.9%), and mortality was recorded in 9 patients (3.8%). Conclusions PPU was more prevalent in males and predominantly located in the duodenum. Ulcer suturing, with or without an omental patch, was the most commonly utilized treatment modality, demonstrating a relatively low complication rate. Further studies are needed to provide more comprehensive and unbiased evidence on PPU in children.

As one of the most prevalent infections globally, Helicobacter pylori (H. pylori) continues to present diagnostic and therapeutic challenges for clinicians worldwide. Diagnostically, the “test-and-treat” strategy is the recommended approach for healthcare practitioners when managing this potentially curable disease. The choice of testing method should be based on several factors including patient age, presenting symptoms, and medication use, as well as test reliability, availability, and cost. With rising antibiotic resistance, particularly of macrolides, care must be taken to ensure that therapy is selected based on regional resistance patterns and prior antibiotic exposure. In the USA, macrolide antibiotic resistance rates in some areas have reached or exceeded a generally accepted threshold, such that clarithromycin triple therapy may no longer be an appropriate first-line empiric treatment. Instead, bismuth quadruple therapy should be considered, while levofloxacin-based or alternative macrolide-containing therapies are also options. Once treated, it is essential to test for eradication as untreated H. pylori is associated with serious complications including peptic ulcer disease, mucosa-associated lymphoid tissue lymphoma, and gastric cancer. This review article aims to consolidate current knowledge of H. pylori infection with a particular emphasis on diagnostic and treatment strategies.

Peptic ulcer is a chronic disease affecting up to 10% of the world’s population. The formation of peptic ulcers depends on the presence of gastric juice pH and the decrease in mucosal defenses. Non-steroidal anti-inflammatory drugs (NSAIDs) and Helicobacter pylori (H. pylori) infection are the two major factors disrupting the mucosal resistance to injury. Conventional treatments of peptic ulcers, such as proton pump inhibitors (PPIs) and histamine-2 (H2) receptor antagonists, have demonstrated adverse effects, relapses, and various drug interactions. On the other hand, medicinal plants and their chemical compounds are useful in the prevention and treatment of numerous diseases. Hence, this review presents common medicinal plants that may be used for the treatment or prevention of peptic ulcers.

Major depressive disorder (MDD) is clinically documented to co-occur with multiple gastrointestinal disorders (GID), but the potential causal relationship between them remains unclear. We aimed to evaluate the potential causal relationship of MDD with 4 GID [gastroesophageal reflux disease (GERD), irritable bowel syndrome (IBS), peptic ulcer disease (PUD), and non-alcoholic fatty liver disease (NAFLD)] using a two-sample Mendelian randomization (MR) design. We obtained genome-wide association data for MDD from a meta-analysis ( = 480 359), and for GID from the UK Biobank ( ranges: 332 601-486 601) and FinnGen ( ranges: 187 028-218 792) among individuals of European ancestry. Our primary method was inverse-variance weighted (IVW) MR, with a series of sensitivity analyses to test the hypothesis of MR. Individual study estimates were pooled using fixed-effect meta-analysis. Meta-analyses IVW MR found evidence that genetically predicted MDD may increase the risk of GERD, IBS, PUD and NAFLD. Additionally, reverse MR found evidence of genetically predicted GERD or IBS may increase the risk of MDD. Genetically predicted MDD may increase the risk of GERD, IBS, PUD and NAFLD. Genetically predicted GERD or IBS may increase the risk of MDD. The findings may help elucidate the mechanisms underlying the co-morbidity of MDD and GID. Focusing on GID symptoms in patients with MDD and emotional problems in patients with GID is important for the clinical management.

Ulcer disorders including the oral mucosa, large intestine, and stomach mucosa, cause significant global health burdens. Conventional treatments such as non-steroid anti-inflammatory drugs (NSAIDs), proton pump inhibitors (PPIs), histamine H receptor antagonists (H RAs), and cytoprotective agents have drawbacks like mucosal injury, diminish gastric acid secretion, and interact with concurrent medications. Therefore, alternative therapeutic approaches are needed to tackle this health concern. Plants are rich in active metabolites in the bark, roots, leaves, fruits, and seeds, and have been utilized for medicinal purposes since ancient times. The use of herbal therapy is crucial, and regulations are necessary to ensure the quality of products, particularly in randomized studies, to assess their efficacy and safety in treating ulcer disorders. This study aims to explore the anti-ulcer activity of medicinal plants in treating peptic ulcer disease, ulcerative colitis, and aphthous ulcers. Articles were searched in Scopus and PubMed, and filtered for publication from 2013 to 2023, resulting in a total of 460 from Scopus and 239 from PubMed. The articles were further screened by title and abstract and resulted in 55 articles. Natural products, rich in active metabolites, were described to manage ulcer disease by protecting the mucosa, reducing ulcer effects, inhibiting pro-inflammatory factors, and reducing bacterial load, thus improving patients' quality of life. Natural extracts have proven effective in managing other health problems, including ulcers by reducing pain and decreasing lesions. This review provides an overview of preclinical and clinical studies on medicinal plants, focusing on their effectiveness in treating conditions like peptic ulcers, ulcerative colitis, and aphthous ulcers.

Enhanced recovery pathways are now widely used in elective surgical procedures. The feasibility of enhanced postoperative recovery pathways in emergency surgery for perforated peptic ulcer disease was investigated in this randomized controlled clinical trial. Patients with perforated peptic ulcer disease who underwent laparoscopic repair were randomized into 2 groups. Group 1 patients were managed with standard postoperative care and group 2 patients with enhanced postoperative recovery pathways. The primary endpoints were the length of hospital stay and morbidity and mortality. Forty-seven patients were included in the study. There were 26 patients in group 1 and 21 in group 2. There were no significant differences in the morbidity and mortality rates, whereas the length of hospital stay was significantly shorter in group 2. The application of enhanced postoperative recovery pathways in selected patients with perforated peptic ulcer disease who undergo laparoscopic Graham patch repair seems feasible.

Background Peptic ulcer disease (PUD) remains a significant yet poorly understood public health issue in Africa, despite its declining prevalence in Western countries. Studies from Africa report a highly variable burden, with the highest prevalence observed in West Africa and the lowest in Southern Africa. However, the overall burden of PUD in Africa, its patterns (duodenal ulcers, gastric ulcers, and coexisting ulcers), and its association with H. pylori infection remain unclear. Objective This review aims to systematically analyze the pooled prevalence and patterns of PUD in Africa through a systematic review and meta-analysis. Design A systematic review and meta-analysis was conducted following the PRISMA checklist. We searched PubMed, Hinari, and Google Scholar, supplemented by Google and Yahoo search engines. Observational studies reporting the prevalence and patterns of PUD among the African population were included. Two independent reviewers extracted data and assessed study quality. Pooled prevalence estimates were calculated using a random-effects model, with heterogeneity assessed via the Cochrane Q test and I 2 statistic. Results A comprehensive analysis of 58 studies revealed a pooled prevalence of PUD in Africa at 15.2%. The most common ulcer pattern was DU at 10.2%, followed by GU at 5.8%, while 0.6% of cases had both types. Regional variations were observed, with West Africa having the highest prevalence (19%), followed by East Africa (15%), North Africa (12%), and Southern Africa (8%). Among individual countries, Ghana reported the highest prevalence (27%), followed by Ethiopia (19%) and Tanzania (16%). Furthermore, the pooled prevalence of PUD was 14% before 2010 and 15% in 2011 and later. Additionally, 57.1% of patients tested positive for Helicobacter pylori infection, with its prevalence reaching 76.4% among those diagnosed with PUD. Substantial heterogeneity was observed across most analyses, with I 2 values exceeding 95% and p -values < 0.001. Conclusion The analysis revealed a significant burden of PUD in Africa, with DU being more common than GU. Regional disparities were observed, with the highest prevalence in West and East Africa. Over the past two decades, the burden has remained relatively stable, reflecting a concerning trend. H. pylori infection was also frequently diagnosed in individuals undergoing endoscopic examination. However, substantial heterogeneity was noted across studies, highlighting variability in reported prevalence.

Menopause is associated with various health conditions such as osteoporosis, obesity, cardiovascular and psychological disorders. However, limited information is available on the relationship between perimenopause and hormone replacement therapy with the occurrence of digestive ulcers. Therefore, we conducted this population-based study of over 17,000 participants in the Taiwan Biobank to examine the association between menopause and peptic ulcer disease (PUD). In addition, we also examined associations between the types of menopause and postmenopausal hormone therapy with PUD. Menopausal status, hormone replacement therapy during menopause, and the presence of PUD were determined using self-reported questionnaires. The participants were grouped according to whether or not they had entered menopause. The participants were further categorized based on the cause of menopause: natural or surgical. Binary logistic regression was utilized for correlation analysis. Of the 17,460 individuals enrolled for analysis, 9620 (55%) were classified into the postmenopausal group and 7840 (45%) into the premenopausal group. After adjusting for various factors, the postmenopausal group had a 1.19 times higher risk of developing PUD compared to the premenopausal group (odds ratio [OR]: 1.19, 95% confidence interval [CI]: 1.03 to 1.38, p  = 0.021). Moreover, surgical menopause was significantly associated with PUD (OR, 1.38; 95% CI, 1.16 to 1.63; p  < 0.001), but natural menopause was not (OR, 1.12; 95% CI, 0.96 to 1.30; p  = 0.147). In addition, the women with natural menopause who received postmenopausal hormone therapy had a significantly higher prevalence of PUD than those who did not (OR, 1.37; 95% CI, 1.13 to 1.67; p  = 0.001). However, no significant association was found between postmenopausal hormone therapy and PUD among the women with surgical menopause ( p  = 0.291). In conclusion, menopause was associated with an elevated risk of PUD, and this relationship may differ by menopause type, with a more pronounced effect observed in surgical menopause. These findings highlight the importance of considering menopausal status and type in future research on gastrointestinal health in women.