Complications of acid-peptic disease: perforation, obstruction, and malignancy

Peptic ulcer disease presents with serious complications, primarily perforation and gastric outlet obstruction, and gastric ulcers carry a higher risk of malignancy. Perforation occurs most frequently in the anterior duodenal wall, and diagnosis is based on signs of peritoneal irritation and imaging studies. While plain radiographs are used, computed tomography offers greater precision, with nearly 90% accuracy in detecting free air. Surgery involving primary closure and an omental patch remains the gold standard treatment, although conservative management may be an option for stable patients under the age of 70. To predict the risk of mortality, the PULP score can be utilized. Gastric outlet obstruction can be either benign or malignant, with malignancy being the most common cause (50-80%), primarily due to adenocarcinoma. Benign causes of obstruction have decreased thanks to the use of proton pump inhibitors and the eradication of Helicobacter pylori; these cases typically respond to endoscopic balloon dilation. For the palliation of malignant obstructions, endoscopic ultrasound using lumen-apposing metal stents provides a less invasive alternative to surgery. Gastric ulcers are linked to cancer through a progression from inflammation to atrophy and intestinal metaplasia. H. pylori is classified as a type I carcinogen, and the risk is significantly elevated by cagA strains and excessive salt intake. Finally, gastric ulcers that fail to heal after appropriate treatment are generally considered to have been malignant from the outset.