<Tr> <Th> Deaths </Th> <Td> 267,500 (2015) </Td> </Tr> <P> Peptic ulcer disease (PUD) is a break in the lining of the stomach, first part of the small intestine or occasionally the lower esophagus . An ulcer in the stomach is known as a gastric ulcer while that in the first part of the intestines is known as a duodenal ulcer . The most common symptoms of a duodenal ulcer are waking at night with upper abdominal pain or upper abdominal pain that improves with eating . With a gastric ulcer the pain may worsen with eating . The pain is often described as a burning or dull ache . Other symptoms include belching, vomiting, weight loss, or poor appetite . About a third of older people have no symptoms . Complications may include bleeding, perforation and blockage of the stomach . Bleeding occurs in as many as 15% of people . </P> <P> Common causes include the bacteria Helicobacter pylori and non-steroidal anti-inflammatory drugs (NSAIDs). Other less common causes include tobacco smoking, stress due to serious illness, Behcet disease, Zollinger - Ellison syndrome, Crohn disease and liver cirrhosis, among others . Older people are more sensitive to the ulcer - causing effects of NSAIDs . The diagnosis is typically suspected due to the presenting symptoms with confirmation by either endoscopy or barium swallow . H. pylori can be diagnosed by testing the blood for antibodies, a urea breath test, testing the stool for signs of the bacteria, or a biopsy of the stomach . Other conditions that produce similar symptoms include stomach cancer, coronary heart disease, and inflammation of the stomach lining or gallbladder inflammation . </P> <P> Diet does not play an important role in either causing or preventing ulcers . Treatment includes stopping smoking, stopping NSAIDs, stopping alcohol and giving medications to decrease stomach acid . The medication used to decrease acid is usually either a proton pump inhibitor (PPI) or an H2 blocker with four weeks of treatment initially recommended . Ulcers due to H. pylori are treated with a combination of medications such as amoxicillin, clarithromycin and a PPI . Antibiotic resistance is increasing and thus treatment may not always be effective . Bleeding ulcers may be treated by endoscopy, with open surgery typically only used in cases in which it is not successful . </P>

The leading cause of peptic ulcer disease is
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