Peptic ulcers are lesions in the gastrointestinal lining, extending through the layer called muscularis mucosae. These lesions usually persist and are dependent on the acid-peptic characteristics of the gastric juice. The most important causes of this disease are the infection with Helicobacter pylori and the use of nonsteroidal antiinflamatory drugs (NSAID), including ibuprofen and aspirin but the patogenesis is multifactorial, the disease being favored by a variety of internal and environmental factors (gastric ph, hereditary factors, alcohol use, smoking, infectious agents and so on).

The classic ulcer symptom is acid dyspepsia, characterized as a burning epigastric pain with a strong tendency to occur when gastric juice is secreted in the absence of a food buffer (hunger pain), especially at night, Antisecretory drugs and food relief the pain, so many authors say that the patients "feed their ulcers".


The pain is localized in the epigastrium but it may also localize in the upper left quadrant or hypochondrium. the pain may also radiate to the back. Even after up to 3 years after the infection with Helybacter pilory has been eradicated, many patients complain of dyspepsia, probably related to sensitization of the nerve endings as a response to tissue injury.

Gastroesophageal reflux disease ) occurs in up to 60% of the patients with peptic ulcer disease. The disease is evident by esophagitis, heartburn and acid relux and there is well known that the obese patients are more predisposed to gastroesophageal reflux disease.

If the patient has not been using nosteroidal antiinflammatory drugs, the complications are mainly associated with a chronic peptic ulcer and mainly consist in the development of ulcer symptoms or in a change in the previous symptom pattern.
The most common complication of peptic ulcer is represented by penetrating ulcers. A penetrating ulcer usually presents with a more localized and intense pain (unlike in uncomplicated disease where the pain is perceived more as a vague visceral one). In pyloric outlet obstruction vomiting is a classical symptom and perforation is indicated by a diffuse, severe abdominal pain, with a sudden onset. Dizziness, melena (tarry, black stools), nausea and hematemesis (vomiting blood) may herald a hemorrhage.

Penetrating ulcers may also lead to fistulae. In the penetrating ulcers localized on the anterior gastric wall colonic fistulae may occur, and the patient presents halitosis (bad-smelling breath), feculent vomiting, dyspepsia, weight loss and postprandial diarrhea. A posterior perforation of an ulcer will have an insidious onset, with protean symptoms (which mainly consist in upper abdominal pain), caused by a localized retroperitoneal abscess or the contamination of by the peritoneal cavity. Hepatic penetration has also been documented.