## Most Common Cause of Peptic Ulcer Disease **Key Point:** Helicobacter pylori (H. pylori) is responsible for approximately 60–90% of peptic ulcer disease globally, and prevalence is particularly high in India due to poor sanitation and crowded living conditions. ### Epidemiology in India H. pylori seropositivity in India ranges from 40–60% in the general population, making it the leading cause of PUD in Indian patients. The bacterium colonizes the gastric mucosa and triggers chronic inflammation, leading to ulcer formation. ### Pathophysiology 1. H. pylori produces urease, which neutralizes gastric acid locally 2. Bacterial lipopolysaccharide and CagA protein trigger mucosal inflammation 3. Increased gastrin secretion and reduced somatostatin lead to increased acid production 4. Mucosal damage exceeds repair capacity → ulcer formation ### Comparison with Other Causes | Cause | Prevalence (India) | Mechanism | Clinical Features | |-------|-------------------|-----------|-------------------| | H. pylori | 60–90% of PUD | Chronic inflammation, increased gastrin | Often asymptomatic; dyspepsia, bleeding | | NSAIDs | 10–30% of PUD | Direct mucosal injury, reduced PGE₂ | Older patients; silent ulcers common | | ZES | <1% of PUD | Severe hyperacidity (gastrin >1000) | Severe, refractory ulcers; diarrhea | | Stress ulcers | <1% of PUD | Mucosal ischemia in critical illness | Acute onset; ICU patients | **High-Yield:** H. pylori-associated ulcers are typically located on the lesser curve of the antrum and prepyloric region; NSAID ulcers are more common on the greater curve and body. **Clinical Pearl:** In India, H. pylori eradication therapy (triple or quadruple regimen) is the standard first-line treatment for H. pylori–positive PUD, with cure rates >90%. **Mnemonic:** **HELP** — H. pylori, Erosion, Lesser curve, Prepyloric (common sites for H. pylori ulcers).
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