Peptic ulcer causes: Difference between revisions
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{{Peptic ulcer}}{{CMG}} | {{Peptic ulcer}} | ||
{{CMG}} ;{{AE}} {{MKK}} | |||
== | ==Overview== | ||
Common causes of [[peptic ulcer]] disease include ''[[Helicobacter pylori]]'' infection and [[NSAID]] use. Less common causes of [[peptic ulcer]] disease include [[Crohn's disease]], [[Zollinger-Ellison syndrome]], [[Cushing's Ulcer|Cushing]] and [[Curling ulcers]], [[Carcinoid tumors]], and [[carcinoid syndrome]]. | |||
==Causes== | |||
'''Common Causes'''<ref name="pmid19683340">{{cite journal| author=Malfertheiner P, Chan FK, McColl KE| title=Peptic ulcer disease. | journal=Lancet | year= 2009 | volume= 374 | issue= 9699 | pages= 1449-61 | pmid=19683340 | doi=10.1016/S0140-6736(09)60938-7 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19683340 }} </ref><ref name="pmid11960062">{{cite journal |vauthors=Hirschowitz BI, Lanas A |title=Atypical and aggressive upper gastrointestinal ulceration associated with aspirin abuse |journal=J. Clin. Gastroenterol. |volume=34 |issue=5 |pages=523–8 |year=2002 |pmid=11960062 |doi= |url=}}</ref><ref name="pmid28150170">{{cite journal |vauthors=Dovjak P |title=[Duodenal ulcers, gastric ulcers and Helicobacter pylori] |language=German |journal=Z Gerontol Geriatr |volume=50 |issue=2 |pages=159–169 |year=2017 |pmid=28150170 |doi=10.1007/s00391-017-1190-x |url=}}</ref> | |||
*[[Helicobacter pylori]] | *[[Helicobacter pylori]] | ||
*[[NSAID]]s | *[[NSAID]]s | ||
'''Less common causes''' | |||
*[[Hormonal]] or mediator-induced including secondary acid hypersecretory states | |||
**[[Gastrinomas]] | |||
** [[Mastocytosis|Systemic mastocytosis]] | |||
** [[Carcinoid syndrome]] | |||
** [[Myeloproliferative disease|Myeloproliferative disorder]] | |||
*Antral G-cell hyperfunction | |||
*Post-surgical antral exclusion and post [[gastric]] bypass [[surgery]] | |||
*Cancers and [[lymphoma|lymphomas]] | |||
*Cameron [[ulcer]] ([[gastric]] [[ulcer]] where a [[hiatus hernia]] passes through the [[diaphragmatic hiatus]]) | |||
*True idiopathic [[ulcer]] | |||
'''Rare causes of peptic ulcer disease''' | |||
* [[Crohn's disease|Crohn’s disease]] of the [[stomach]] or [[duodenum]] | |||
* [[Eosinophilic gastroduodenitis]] | |||
* Systemic [[mastocytosis]] | |||
* [[Radiation]] damage | |||
* [[Viral infections]] (eg [[cytomegalovirus]] or [[Herpes simplex|herpes simplex infection]], in particular in [[immunocompromised]] patients) | |||
*Colonization of [[stomach]] with H heilmanii | |||
* Severe [[systemic disease]] | |||
'''Genetic causes'''<ref name="pmid17312377">{{cite journal| author=Jensen RT, Niederle B, Mitry E, Ramage JK, Steinmuller T, Lewington V et al.| title=Gastrinoma (duodenal and pancreatic). | journal=Neuroendocrinology | year= 2006 | volume= 84 | issue= 3 | pages= 173-82 | pmid=17312377 | doi=10.1159/000098009 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17312377 }} </ref> | |||
*Peptic ulcer disease caused by gastrinomas [[Zollinger-Ellison syndrome|(Zollinger-Ellison syndrome]]) caused by a [[mutation]] in MEN [[gene]] present on [[chromosome]] 11q13 | |||
===Causes by Organ System=== | |||
{| style="width:80%; height:100px" border="1" | |||
| style="width:25%" bgcolor="LightSteelBlue" ; border="1" | '''Cardiovascular''' | |||
{|style="width:80%; height:100px" border="1" | | style="width:75%" bgcolor="Beige" ; border="1" | No underlying causes | ||
| | |||
| | |||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Chemical / poisoning''' | | '''Chemical / poisoning''' | ||
|bgcolor="Beige"| No underlying causes | | bgcolor="Beige" | No underlying causes | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Dermatologic''' | | '''Dermatologic''' | ||
|bgcolor="Beige"| | | bgcolor="Beige" | [[Rosacea]],Chronic idiopathic [[urticaria]] ,[[Psoriasis|Psoriasis vulgaris]] ,[[Behçet's disease|Behcet's disease]] ,[[Alopecia areata]],[[Sweet's syndrome]] <ref name="pmid25045884">{{cite journal| author=Kutlubay Z, Zara T, Engin B, Serdaroğlu S, Tüzün Y, Yilmaz E et al.| title=Helicobacter pylori infection and skin disorders. | journal=Hong Kong Med J | year= 2014 | volume= 20 | issue= 4 | pages= 317-24 | pmid=25045884 | doi=10.12809/hkmj134174 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25045884 }} </ref> | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Drug Side Effect''' | | '''Drug Side Effect''' | ||
|bgcolor="Beige"| [[Aceclofenac]], [[Acemetacin]], [[Alendronate]], [[Aspirin]], [[Azapropazone]], [[Benoxaprofen]], [[Bisphosphonates]], [[Celecoxib]], [[Clopidogrel]], [[Diclofenac]], [[Diflunisal]], [[Ethanol]], [[Etodolac]], [[Etoricoxib]], [[Fenbufen]], [[Fenoprofen]], [[Flurbiprofen]], [[Glucocorticoids]], [[Ibuprofen]], [[Indomethacin]], [[Ketoprofen]], [[Laxative abuse]], [[Mefenamic acid]], [[Meloxicam]], [[Nabumetone]], [[Naproxen]], [[Non steroidal anti-inflammatory drugs]], [[Para-amino salicylic acid]], [[Phenylbutazone]], [[Piroxicam]], [[Prednisolone]], [[Rofecoxib]], [[Sulindac]], [[Tacrolimus]], [[Tenoxicam]], [[Tiaprofenic acid]], [[Tolazoline]], [[Trimetrexate]] | | bgcolor="Beige" | [[Aceclofenac]], [[Acemetacin]], [[Alendronate]], [[Artemether and lumefantrin]], [[Aspirin]], [[Azapropazone]], [[Benoxaprofen]], [[Bisphosphonates]], [[Carbinoxamine]], [[Celecoxib]], [[Clopidogrel]], [[Dexamethasone]], [[Diclofenac]], [[Diflunisal]], [[Ethanol]], [[ethanolamine oleate]], [[Etidronic acid]], [[Etodolac]], [[Etoricoxib]], [[Febuxostat]], [[Fenbufen]], [[Fenoprofen]], [[Flurbiprofen]], [[Glucocorticoids]], [[Hydrocortisone]], [[Ibuprofen]], [[Indomethacin]], [[Ketoprofen]], [[Laxative abuse]], [[Mefenamic acid]], [[Meloxicam]], [[Mepenzolate bromide]], [[Methylprednisolone]], [[Nabumetone]], [[Naproxen]], [[Naproxen and esomeprazole magnesium]], [[Niacin]], [[Non steroidal anti-inflammatory drugs]], [[Oxcarbazepine]], [[Para-amino salicylic acid]], [[Pergolide]], [[Phenylbutazone]], [[Pramipexole]], [[Piroxicam]], [[Pramipexole]], [[Prednisolone]], [[Prednisone]], [[Rofecoxib]], [[Sertraline]], [[Sulindac]], [[Tacrolimus]], [[Tenoxicam]], [[Tiaprofenic acid]], [[Tocilizumab]], [[Tolazoline]], [[Tolmetin]], [[Trimetrexate]] | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Ear Nose Throat''' | | '''Ear Nose Throat''' | ||
|bgcolor="Beige"| No underlying causes | | bgcolor="Beige" | No underlying causes | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Endocrine''' | | '''Endocrine''' | ||
|bgcolor="Beige"| [[Cushing syndrome]], [[Multiple endocrine neoplasia type 1]], [[Zollinger-Ellison syndrome]] | | bgcolor="Beige" | [[Cushing syndrome]], [[Multiple endocrine neoplasia type 1]], [[Zollinger-Ellison syndrome]], [[Hyperparathyroidism|primary hyperparathyroidism]] | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Environmental''' | | '''Environmental''' | ||
|bgcolor="Beige"| No underlying causes | | bgcolor="Beige" | No underlying causes | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Gastroenterologic''' | | '''Gastroenterologic''' | ||
|bgcolor="Beige"| [[Crohn disease]], [[Cushing ulcers]], [[Dieulafoy's lesion]], [[Duodenal ulcer]], [[Eosinophilic gastroenteritis]], [[Gastric ulcer]], [[Oesophagitis]], [[Zollinger-Ellison syndrome]], [[Carcinoid tumours and carcinoid syndrome]], [[Stomach cancer]], [[Curling ulcers]] | | bgcolor="Beige" | [[Crohn disease]], [[Cushing ulcers]], [[Dieulafoy's lesion]], [[Duodenal ulcer]], [[Eosinophilic gastroenteritis]], [[Gastric ulcer]], [[Oesophagitis]], [[Zollinger-Ellison syndrome]], [[Carcinoid tumours and carcinoid syndrome]], [[Stomach cancer]], [[Curling ulcers]] | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Genetic''' | | '''Genetic''' | ||
|bgcolor="Beige"| | | bgcolor="Beige" | [[Zollinger -Ellison syndrome]] associated with [[MEN TYPE 1]] syndrome caused by mutation in MEN [[gene]] present on [[chromosome]] 11q 13 | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- | ||
|- bgcolor="LightSteelBlue" | |||
| '''Hematologic''' | | '''Hematologic''' | ||
|bgcolor="Beige"| [[Mastocytosis]], [[Polycythaemia rubra vera]], [[Primary thrombocythemia]] | | bgcolor="Beige" | [[Mastocytosis]], [[Polycythaemia rubra vera]], [[Primary thrombocythemia]] | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Iatrogenic''' | | '''Iatrogenic''' | ||
|bgcolor="Beige"| [[Mechanical ventilation]] | | bgcolor="Beige" | [[Mechanical ventilation]] | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Infectious Disease''' | | '''Infectious Disease''' | ||
|bgcolor="Beige"| [[Helicobacter pylori]] | | bgcolor="Beige" | [[Helicobacter pylori]] | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Musculoskeletal / Ortho''' | | '''Musculoskeletal / Ortho''' | ||
|bgcolor="Beige"| No underlying causes | | bgcolor="Beige" | No underlying causes | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Neurologic''' | | '''Neurologic''' | ||
|bgcolor="Beige"| [[Cushing ulcers]] | | bgcolor="Beige" | [[Cushing ulcers]] | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Nutritional / Metabolic''' | | '''Nutritional / Metabolic''' | ||
|bgcolor="Beige"| [[Hypercalcaemia]] | | bgcolor="Beige" | [[Hypercalcaemia]] | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Obstetric/Gynecologic''' | | '''Obstetric/Gynecologic''' | ||
|bgcolor="Beige"| No underlying causes | | bgcolor="Beige" | No underlying causes | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Oncologic''' | | '''Oncologic''' | ||
|bgcolor="Beige"| [[Carcinoid tumours and carcinoid syndrome]], [[Stomach cancer]], [[Zollinger-Ellison syndrome]] | | bgcolor="Beige" | [[Carcinoid tumours and carcinoid syndrome]], [[Stomach cancer]], [[Zollinger-Ellison syndrome|Zollinger-Ellison syndrome ,]] [[gastrinomas]] | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Opthalmologic''' | | '''Opthalmologic''' | ||
|bgcolor="Beige"| No underlying causes | | bgcolor="Beige" | No underlying causes | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Overdose / Toxicity''' | | '''Overdose / Toxicity''' | ||
|bgcolor="Beige"| [[Aceclofenac]], [[Acemetacin]], [[Alendronate]], [[Aspirin]], [[Azapropazone]], [[Benoxaprofen]], [[Bisphosphonates]], [[Celecoxib]], [[Clopidogrel]], [[Diclofenac]], [[Diflunisal]], [[Ethanol]], [[Etodolac]], [[Etoricoxib]], [[Fenbufen]], [[Fenoprofen]], [[Flurbiprofen]], [[Glucocorticoids]], [[Ibuprofen]], [[Indomethacin]], [[Ketoprofen]], [[Laxative abuse]], [[Mefenamic acid]], [[Meloxicam]], [[Nabumetone]], [[Naproxen]], [[Non steroidal anti-inflammatory drugs]], [[Para-amino salicylic acid]], [[Phenylbutazone]], [[Piroxicam]], [[Prednisolone]], [[Rofecoxib]], [[Sulindac]], [[Tacrolimus]], [[Tenoxicam]], [[Tiaprofenic acid]], [[Tolazoline]], [[Trimetrexate]] | | bgcolor="Beige" | [[Aceclofenac]], [[Acemetacin]], [[Alendronate]], [[Aspirin]], [[Azapropazone]], [[Benoxaprofen]], [[Bisphosphonates]], [[Celecoxib]], [[Clopidogrel]], [[Diclofenac]], [[Diflunisal]], [[Ethanol]], [[Etodolac]], [[Etoricoxib]], [[Fenbufen]], [[Fenoprofen]], [[Flurbiprofen]], [[Glucocorticoids]], [[Ibuprofen]], [[Indomethacin]], [[Ketoprofen]], [[Laxative abuse]], [[Mefenamic acid]], [[Meloxicam]], [[Nabumetone]], [[Naproxen]], [[Non steroidal anti-inflammatory drugs]], [[Para-amino salicylic acid]], [[Phenylbutazone]], [[Piroxicam]], [[Prednisolone]], [[Rofecoxib]], [[Sulindac]], [[Tacrolimus]], [[Tenoxicam]], [[Tiaprofenic acid]], [[Tolazoline]], [[Trimetrexate]] | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Psychiatric''' | | '''Psychiatric''' | ||
|bgcolor="Beige"| [[Curling ulcers]] | | bgcolor="Beige" | [[Curling ulcers]] | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Pulmonary''' | | '''Pulmonary''' | ||
|bgcolor="Beige"| | | bgcolor="Beige" | [[Sarcoidosis]] | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Renal / Electrolyte''' | | '''Renal / Electrolyte''' | ||
|bgcolor="Beige"| | | bgcolor="Beige" | [[Hypercalcemia]] | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Rheum / Immune / Allergy''' | | '''Rheum / Immune / Allergy''' | ||
|bgcolor="Beige"| | | bgcolor="Beige" | [[Fibromyalgia]]<ref name="pmid28384332" /> | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Sexual''' | | '''Sexual''' | ||
|bgcolor="Beige"| No underlying causes | | bgcolor="Beige" | No underlying causes | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Trauma''' | | '''Trauma''' | ||
|bgcolor="Beige"| [[Burns]] | | bgcolor="Beige" | [[Burns]] | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Urologic''' | | '''Urologic''' | ||
|bgcolor="Beige"| No underlying causes | | bgcolor="Beige" | No underlying causes | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Dental''' | | '''Dental''' | ||
|bgcolor="Beige"| No underlying causes | | bgcolor="Beige" | No underlying causes | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Miscellaneous''' | | '''Miscellaneous''' | ||
|bgcolor="Beige"| [[Alcohol]], [[Caffeine]], [[Smoking]] | | bgcolor="Beige" | [[Alcohol]], [[Caffeine]], [[Smoking]] | ||
|- | |- | ||
|} | |} | ||
== Causes in Alphabetical Order == | ===Causes in Alphabetical Order=== | ||
{{MultiCol}} | {{MultiCol|80%}} | ||
*[[Aceclofenac]] | *[[Aceclofenac]] | ||
*[[Acemetacin]] | *[[Acemetacin]] | ||
*[[Alcohol]] | *[[Alcohol]] | ||
*[[Alendronate]] | *[[Alendronate]] | ||
*[[Artemether and lumefantrin]] | |||
*[[Aspirin]] | *[[Aspirin]] | ||
*[[Azapropazone]] | *[[Azapropazone]] | ||
Line 144: | Line 169: | ||
*[[Cushing syndrome]] | *[[Cushing syndrome]] | ||
*[[Cushing ulcers]] | *[[Cushing ulcers]] | ||
*[[Dexamethasone]] | |||
*[[Diclofenac]] | *[[Diclofenac]] | ||
*[[Dieulafoy's lesion]] | *[[Dieulafoy's lesion]] | ||
Line 171: | Line 197: | ||
*[[Nabumetone]] | *[[Nabumetone]] | ||
*[[Naproxen]] | *[[Naproxen]] | ||
*[[Niacin]] | |||
*[[Non steroidal anti-inflammatory drugs]] | *[[Non steroidal anti-inflammatory drugs]] | ||
*[[Oesophagitis]] | *[[Oesophagitis]] | ||
*[[Para-amino salicylic acid]] | *[[Para-amino salicylic acid]] | ||
*[[Pergolide]] | |||
*[[Phenylbutazone]] | *[[Phenylbutazone]] | ||
*[[Piroxicam]] | *[[Piroxicam]] | ||
Line 193: | Line 221: | ||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
{{WikiDoc Help Menu}} | {{WikiDoc Help Menu}} | ||
{{WikiDoc Sources}} | {{WikiDoc Sources}} | ||
[[Category:Gastroenterology]] |
Latest revision as of 23:37, 29 July 2020
Peptic ulcer Microchapters |
Diagnosis |
---|
Treatment |
Surgery |
Case Studies |
2017 ACG Guidelines for Peptic Ulcer Disease |
Guidelines for the Indications to Test for, and to Treat, H. pylori Infection |
Guidlines for factors that predict the successful eradication when treating H. pylori infection |
Guidelines to document H. pylori antimicrobial resistance in the North America |
Guidelines for evaluation and testing of H. pylori antibiotic resistance |
Guidelines for when to test for treatment success after H. pylori eradication therapy |
Guidelines for penicillin allergy in patients with H. pylori infection |
Peptic ulcer causes On the Web |
American Roentgen Ray Society Images of Peptic ulcer causes |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ;Associate Editor(s)-in-Chief: Manpreet Kaur, MD [2]
Overview
Common causes of peptic ulcer disease include Helicobacter pylori infection and NSAID use. Less common causes of peptic ulcer disease include Crohn's disease, Zollinger-Ellison syndrome, Cushing and Curling ulcers, Carcinoid tumors, and carcinoid syndrome.
Causes
Less common causes
- Hormonal or mediator-induced including secondary acid hypersecretory states
- Antral G-cell hyperfunction
- Post-surgical antral exclusion and post gastric bypass surgery
- Cancers and lymphomas
- Cameron ulcer (gastric ulcer where a hiatus hernia passes through the diaphragmatic hiatus)
- True idiopathic ulcer
Rare causes of peptic ulcer disease
- Crohn’s disease of the stomach or duodenum
- Eosinophilic gastroduodenitis
- Systemic mastocytosis
- Radiation damage
- Viral infections (eg cytomegalovirus or herpes simplex infection, in particular in immunocompromised patients)
- Colonization of stomach with H heilmanii
- Severe systemic disease
Genetic causes[4]
- Peptic ulcer disease caused by gastrinomas (Zollinger-Ellison syndrome) caused by a mutation in MEN gene present on chromosome 11q13
Causes by Organ System
Causes in Alphabetical Order
References
- ↑ Malfertheiner P, Chan FK, McColl KE (2009). "Peptic ulcer disease". Lancet. 374 (9699): 1449–61. doi:10.1016/S0140-6736(09)60938-7. PMID 19683340.
- ↑ Hirschowitz BI, Lanas A (2002). "Atypical and aggressive upper gastrointestinal ulceration associated with aspirin abuse". J. Clin. Gastroenterol. 34 (5): 523–8. PMID 11960062.
- ↑ Dovjak P (2017). "[Duodenal ulcers, gastric ulcers and Helicobacter pylori]". Z Gerontol Geriatr (in German). 50 (2): 159–169. doi:10.1007/s00391-017-1190-x. PMID 28150170.
- ↑ Jensen RT, Niederle B, Mitry E, Ramage JK, Steinmuller T, Lewington V; et al. (2006). "Gastrinoma (duodenal and pancreatic)". Neuroendocrinology. 84 (3): 173–82. doi:10.1159/000098009. PMID 17312377.
- ↑ Kutlubay Z, Zara T, Engin B, Serdaroğlu S, Tüzün Y, Yilmaz E; et al. (2014). "Helicobacter pylori infection and skin disorders". Hong Kong Med J. 20 (4): 317–24. doi:10.12809/hkmj134174. PMID 25045884.
- ↑