Peptic ulcer disease.

Peptic ulcer disease affects between 5 percent and 10 percent of Americans during their lifetime. There are a variety of predisposing factors, including nonsteroidal anti-inflammatory drug (NSAID) use, Helicobacter pylori infection, tobacco use and, possibly, certain dietary practices. While H2-receptor antagonists remain the mainstay of therapy, the selection of an antiulcer drug should be individualized. Famotidine is preferred in persons who use alcohol, sucralfate may be preferred for maintenance therapy in smokers and omeprazole is useful in hypersecretors of acid and in patients with resistant ulcers. Antacids remain an effective treatment for uncomplicated duodenal ulcer in motivated patients. Eradication of H. pylori using a bismuth preparation plus one or two antibiotic agents should be considered in patients who have frequent recurrences and evidence of infection. Finally, risk factors such as tobacco or NSAID use should be modified whenever possible to reduce the risk of ulcer recurrence.