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| | __NOTOC__ |
| {{Infobox_Disease | | | {{Infobox_Disease | |
| Name = {{PAGENAME}} | | | Name = {{PAGENAME}} | |
| Image = Deep gastric ulcer.png | | | Image = Deep gastric ulcer.png | |
| Caption = Deep gastric ulcer | | | Caption = Deep gastric ulcer | |
| DiseasesDB = 9819 |
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| ICD10 = {{ICD10|K|25||k|20}}-{{ICD10|K|27||k|20}} |
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| ICD9 = {{ICD9|531}}-{{ICD9|534}} |
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| ICDO = |
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| OMIM = |
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| MedlinePlus = |
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| eMedicineSubj = |
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| eMedicineTopic = |
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| eMedicine_mult = |
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| MeshID = D010437 |
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| }} | | }} |
| {{Peptic ulcer}} | | {{Peptic ulcer}} |
| '''For patient information click [[{{PAGENAME}} (patient information)|here]]'''
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| {{CMG}} | | {{CMG}} ; {{AE}} {{MKK}} |
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| ==Overview==
| | {{SK}} Gastroduodenal ulcers; Peptic ulceration; gastric ulcer; duodenal ulcer. |
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| == Epidemiology == | | ==[[Peptic ulcer overview|Overview]]== |
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| ==History== | | ==[[Peptic ulcer historical perspective|Historical Perspective]]== |
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| ==Classification== | | ==[[Peptic ulcer classification|Classification]]== |
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| == Pathophysiology ==
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| == Diagnosis == | | ==[[Peptic ulcer pathophysiology|Pathophysiology]]== |
| An [[esophagogastroduodenoscopy]] ([[EGD]]), a form of [[endoscopy]], also known as a [[gastroscopy]], is carried out on patients in whom a peptic ulcer is suspected. By direct visual identification, the location and severity of an ulcer can be described. Moreover, if no ulcer is present, EGD can often provide an alternative diagnosis.
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| The diagnosis of ''[[Helicobacter pylori]]'' can be by:
| | ==[[Peptic ulcer causes|Causes]]== |
| *Breath testing (does not require EGD);
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| *Direct culture from an EGD biopsy specimen;
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| *Direct detection of [[urease]] activity in a biopsy specimen;
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| *Measurement of [[antibody]] levels in [[blood]] (does not require EGD). It is still somewhat controversial whether a positive antibody without EGD is enough to warrant eradication therapy.
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| The possibility of other causes of ulcers, notably [[malignancy]] ([[gastric cancer]]) needs to be kept in mind. This is especially true in ulcers of the ''greater (large) curvature'' of the [[stomach]]; most are also a consequence of chronic ''H. pylori'' infection.
| | ==[[Peptic ulcer differential diagnosis|Differentiating Peptic ulcer from other Diseases]]== |
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| If a peptic ulcer perforates, air will leak from the inside of the gastrointestinal tract (which always contains some air) to the peritoneal cavity (which normally never contains air). This leads to "free gas" within the peritoneal cavity. If the patient stands erect, as when having a chest X-ray, the gas will float to a position underneath the diaphragm. Therefore, gas in the peritoneal cavity, shown on an erect chest X-ray or supine lateral abdominal X-ray, is an omen of perforated peptic ulcer disease.
| | ==[[Peptic ulcer epidemiology and demographics|Epidemiology and Demographics]]== |
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| ===Macroscopical appearance=== | | ==[[Peptic ulcer risk factors|Risk Factors]]== |
| Gastric ulcers are most often localized on the lesser curvature of the stomach. The ulcer is a round to oval parietal defect ("hole"), 2 to 4 cm diameter, with a smooth base and perpendicular borders. These borders are not elevated or irregular as in the ulcerative form of gastric cancer. Surrounding mucosa may present radial folds, as a consequence of the parietal scarring.
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| ===Microscopical appearance=== | | ==[[Peptic ulcer screening|Screening]]== |
| A gastric peptic ulcer is a mucosal defect which penetrates the [[muscularis mucosae]] and muscularis propria, produced by acid-pepsin aggression. Ulcer margins are perpendicular and present chronic gastritis. During the active phase, the base of the ulcer shows 4 zones: inflammatory exudate, fibrinoid necrosis, granulation tissue and fibrous tissue. The fibrous base of the ulcer may contain vessels with thickened wall or with thrombosis.<ref name="pathologyatlas">{{cite web | url= http://www.pathologyatlas.ro/Peptic%20ulcer.html| title=ATLAS OF PATHOLOGY|accessdate=2007-08-26}}</ref>
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| == Differential Diagnosis == | | ==[[Peptic ulcer natural history|Natural History, Complications and Prognosis]]== |
| *Alcohol
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| *[[Alpha-1 Antitrypsin Deficiency]]
| | ==[[Peptic ulcer diagnosis|Diagnosis]]== |
| *Basophilic leukemia
| | [[Peptic ulcer history and symptoms|History and Symptoms]] | [[Peptic ulcer physical examination|Physical Examination]] | [[Peptic ulcer Echocardiogram|Echocardiogram]] | [[Peptic ulcer laboratory tests|Laboratory Findings]] | [[Peptic ulcer x ray| X Ray]] | [[Peptic ulcer CT|CT]] | [[Peptic ulcer ultrasound|Ultrasound]] | [[Peptic ulcer other imaging findings|Other Imaging Findings]] | [[Peptic ulcer other diagnostic studies|Other Diagnostic Studies]] |
| *[[Burn]]s
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| *Cerebral [[trauma]]
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| *Chronic debilitated conditions
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| *[[Chronic obstructive pulmonary disease]]
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| *[[Chronic Renal Failure]]
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| *Cigarette smoking
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| *[[Cirrhosis]]
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| *[[Cystic Fibrosis]]
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| *Glucosteroids
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| *[[Helicobacter pylori infection]]
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| *[[Hyperparathyroidism]]
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| *Incompetant gastroesophageal sphincter
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| *[[NSAID]]s
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| *Severe systemic disease
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| *[[Zollinger-Ellison Syndrome]]
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| ==Treatment== | | ==Treatment== |
| | [[Peptic ulcer medical therapy|Medical Therapy]] | [[Peptic ulcer surgery|Surgery]] | [[Peptic ulcer primary prevention|Primary Prevention]] | [[Peptic ulcer secondary prevention|Secondary Prevention]] | [[Peptic ulcer cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Peptic ulcer future or investigational therapies|Future or Investigational Therapies]] |
| | ==Case Studies== |
| | [[Peptic ulcer case study one|Case #1]] |
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| Younger patients with ulcer-like symptoms are often treated with [[antacid]]s or [[H2 antagonist]]s before EGD is undertaken. [[Bismuth subsalicylate|Bismuth compounds]] may actually reduce or even clear organisms.
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| Patients who are taking [[NSAIDs|nonsteroidal anti-inflammatories]] (NSAIDs) may also be prescribed a [[prostaglandin]] [[analog (chemistry)|analogue]] ([[Misoprostol]]) in order to help prevent peptic ulcers, which may be a side-effect of the NSAIDs.
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| When ''H. pylori'' infection is present, the most effective treatments are combinations of 2 antibiotics (e.g. [[Erythromycin]], [[Ampicillin]], [[Amoxicillin]], [[Tetracycline]], [[Metronidazole]]) and 1 [[proton pump inhibitor]] (PPI). An effective combination would be [[Amoxicillin]] + [[Metronidazole]] + [[Pantoprazole]] (a PPI). In the absence of ''H. pylori'', long-term higher dose PPIs are often used.
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| Treatment of ''H. pylori'' usually leads to clearing of infection, relief of symptoms and eventual healing of ulcers. Recurrence of infection can occur and retreatment may be required, if necessary with other antibiotics. Since the widespread use of PPI's in the 1990s, surgical procedures (like "highly selective [[vagotomy]]") for uncomplicated peptic ulcers became obsolete.
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| Perforated peptic ulcer is a surgical emergency and requires surgical repair of the perforation. Most bleeding ulcers require endoscopy urgently to stop bleeding with cauterizations or injection.
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| ==Complications==
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| *'''[[Upper gastrointestinal bleeding|Gastrointestinal bleeding]]''' is the commonest complication. Sudden large bleeding can be life threatening<ref name="pmid9391242">{{cite journal |author=Cullen DJ, Hawkey GM, Greenwood DC, ''et al'' |title=Peptic ulcer bleeding in the elderly: relative roles of Helicobacter pylori and non-steroidal anti-inflammatory drugs |journal=Gut |volume=41 |issue=4 |pages=459–62 |year=1997 |pmid=9391242 |doi=}}</ref>. It occurs when the ulcer erodes one of the blood vessels.
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| *'''Perforation''' (a hole in the wall) often leads to catastrophic consequences. Erosion of the gastro-intestinal wall by the ulcer leads to spillage of stomach or intestinal content into abdominal cavity. Perforation at the anterior surface of stomach leads to acute [[peritonitis]], initially chemical and later bacterial peritonitis. Often first sign is sudden intense abdominal pain. Posterior wall perforation leads to [[pancreatitis]]; pain in this situation often radiates to back.
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| *'''Penetration''' is when the ulcer continues into adjacent organs such as liver and [[pancreas]]<ref>{{cite web |url=http://www.merck.com/mmhe/sec09/ch121/ch121c.html |title=Peptic Ulcer: Peptic Disorders: Merck Manual Home Edition |accessdate=2007-10-10 |format= |work=}}</ref>.
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| *Scarring and swelling due to ulcers causes narrowing in the duodenum and '''[[gastric outlet obstruction]]'''. Patient often presents with severe vomiting.
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| ==References==
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| {{reflist|2}}
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| == External links ==
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| *[http://www.pathologyatlas.ro/Peptic%20ulcer.html Pathology specimen of Gastric ulcer]
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| *[http://www.surgeons.org.uk/general-surgery/perforated-duodenal-ulceration.html A case report and tutorial on perforated duodenal ulcer]
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| *[http://www.peptic-ulcers.co.uk/causes.html Causes of Peptic ulcers]
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| {{SIB}}
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| {{Gastroenterology}} | | {{Gastroenterology}} |
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| [[Category:Gastroenterology]]
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| [[Category:Abdominal pain]]
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| [[bs:Ulcerozne lezije želuca]] | | [[bs:Ulcerozne lezije želuca]] |
| [[ca:Úlcera pèptica]] | | [[ca:Úlcera pèptica]] |
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| {{WikiDoc Help Menu}} | | {{WikiDoc Help Menu}} |
| {{WikiDoc Sources}} | | {{WikiDoc Sources}} |
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| | [[Category:Gastroenterology]] |
| | [[Category:Disease]] |
