Review of Peptic Ulcer Disease: Insights from Pathophysiology, Mechanisms, Pharmacotherapy, Phytotherapy, and Case Reports

Abstract: Peptic ulcer disease (PUD) remains a significant global health concern associated with substantial morbidity. The primary etiologies include Helicobacter pylori infection and the use of nonsteroidal anti-inflammatory drugs (NSAIDs), both of which impair gastric mucosal defense mechanisms. This review aims to provide an updated overview of the pathogenesis, clinical manifestations, diagnostic approaches, and current management strategies of PUD, including emerging therapeutic developments. Advances in diagnostic modalities, such as endoscopy and imaging, have improved early detection and clinical outcomes. Current management focuses on H. pylori eradication, gastric acid suppression with proton pump inhibitors (PPIs), and prevention of complications. Recent advances in peptic ulcer therapy include the introduction of potassium-competitive acid blockers (P-CABs), which provide rapid and potent acid suppression and may serve as an effective alternative to PPIs in selected patients. In cases of bleeding ulcers, endoscopic therapy combined with high-dose PPI administration remains the standard of care. Case reports from multiple countries demonstrate a wide clinical spectrum, ranging from mild dyspepsia to severe complications such as perforation and upper gastrointestinal bleeding. Common risk factors include chronic NSAID use, smoking, anticoagulant therapy, and persistent H. pylori infection. Diagnosis is established through laboratory evaluation, imaging, and endoscopy, while treatment ranges from pharmacological therapy to emergency surgical intervention in severe cases. Most patients show favourable outcomes with timely management, although mortality may still occur in complicated conditions. Emerging challenges, particularly antibiotic resistance, have led to the adoption of tailored therapeutic strategies based on antimicrobial susceptibility testing. In addition, novel approaches, including phytotherapy, are being explored as potential adjuncts. An individualized and evidence-based approach is therefore essential to optimize clinical outcomes in patients with PUD. Keywords: gastric ulcer, gastric mucosal protection, Helicobacter pylori, potassium-competitive acid blockers, proton pump inhibitor