Peptic Ulcer Disease

A patient reports burning epigastric pain that worsens with eating versus one whose pain improves with food — that single distinction tells you which ulcer type you're dealing with and changes every nursing priority.

Peptic ulcer disease (PUD) involves erosion of the GI mucosa, most commonly caused by Helicobacter pylori infection (~60-70% of cases) or chronic NSAID use. The two major types differ in clinically testable ways. Gastric ulcers cause pain that worsens 30-60 minutes after eating — food irritates the damaged mucosa. These clients often have weight loss because they avoid eating. Duodenal ulcers cause pain 2-4 hours after meals or at night when the stomach is empty; food and antacids relieve the pain, so these clients may actually gain weight. Duodenal ulcers are more common overall. Diagnosis is confirmed by esophagogastroduodenoscopy (EGD). Triple therapy for H. pylori eradication typically combines a proton pump inhibitor with two antibiotics (e.g., clarithromycin and amoxicillin) for 14 days. Nursing priorities include monitoring for perforation signs — sudden, severe 'board-like' abdominal rigidity with referred shoulder pain — which is a surgical emergency. You teach the client to avoid NSAIDs, alcohol, and smoking, all of which impair mucosal healing.

Key Distinctions

Don't confuse gastric ulcer pain (worse with food, weight loss) with duodenal ulcer pain (relieved by food, possible weight gain) — NCLEX tests this distinction frequently. Students mix up PUD perforation (sudden rigid abdomen, free air on X-ray) with upper GI bleeding (hematemesis, melena) — perforation is a peritonitis picture, not primarily a bleeding picture. H. pylori can be confirmed noninvasively by urea breath test or stool antigen; EGD with biopsy-based rapid urease test is also a valid confirmatory method.

Clinical Pearl

Gastric ulcer = pain with meals (food hurts). Duodenal ulcer = pain between meals (food helps). Think: G for 'Greater pain with food,' D for 'Decreased pain with food.'