349 Ch 348. Peptic Ulcer Disease, H. pylori, and Functional Dyspepsia

PUD (peptic ulcer disease) = mucosal break > 5 mm penetrating muscularis mucosa；duodenal ulcer > gastric ulcer；etiologies：(1) H. pylori (most common globally — 70-95% DU, 60-80% GU)；(2) NSAIDs (most common in developed)；(3) acid-peptic + stress + Zollinger-Ellison + idiopathic；symptoms = epigastric pain (worse with food in GU; relieved in DU)；complications：bleeding (UGIB), perforation, obstruction, malignancy；diagnosis：EGD + biopsy (rule out cancer for GU)；H. pylori testing：urea breath test, stool antigen, biopsy (CLO test)；treatment：quadruple therapy preferred (bismuth + PPI + tetracycline + metronidazole; 14 d) OR clarithromycin-based triple if resistance < 15% (PPI + clarithromycin + amoxicillin); vonoprazan-based (FDA 2022) emerging; functional dyspepsia (Rome IV) = postprandial distress syndrome + epigastric pain syndrome; PPI, H. pylori eradication, prokinetics, TCA/SSRI; Zollinger-Ellison syndrome = gastrinoma + ↑ gastrin + multiple/refractory ulcers, MEN1 association；2024 vonoprazan-amoxicillin dual therapy + vonoprazan-based triple emerging for H. pylori resistance era。