Gastric Ulcer: An Overview of Pathophysiology, Diagnosis, and Management

Gastric ulcer (GU) remains a significant global health problem, affecting millions of individuals and contributing to considerable morbidity and economic burden. Despite major advances in understanding its pathophysiology and treatment, GU continues to present clinical challenges due to its multifactorial etiology and potential complications. The development of GU is primarily linked to an imbalance between aggressive factors, such as Helicobacter pylori (H. pylori) infection, nonsteroidal anti-inflammatory drug (NSAID) use, gastric acid hypersecretion, and oxidative stress, and protective mechanisms including mucus-bicarbonate barrier, prostaglandins, and mucosal blood flow. Lifestyle factors, smoking, alcohol intake, and comorbidities further exacerbate disease progression. Advances in diagnostic tools, ranging from endoscopy to molecular biomarkers, have improved detection and risk stratification. Current therapeutic strategies include proton pump inhibitors, H2 receptor antagonists, eradication regimens for H. pylori, and mucosal protective agents, with emerging interest in antioxidants, immunomodulators, and phytochemicals as adjunctive therapies. However, rising antibiotic resistance, adverse drug effects, and ulcer recurrence underscore the need for novel pharmacological targets and alternative therapies. This review provides a comprehensive overview of GU, covering its epidemiology, risk factors, pathophysiological mechanisms, diagnostic approaches, current treatment options, and future perspectives, with emphasis on integrating clinical, pharmacological, and experimental evidence to guide effective management and identify research gaps.