Peptic ulcer classification: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Peptic ulcer}} | {{Peptic ulcer}} | ||
{{CMG}}; {{AE}} | {{CMG}} ; {{AE}} {{MKK}} | ||
==Overview== | ==Overview== | ||
Peptic ulcer disease may be classified into two | [[Peptic ulcer]] disease may be classified into two types based on the location within the gastrointestinal tract. [[gastric]] [[ulcer]] and [[duodenal]] [[ulcer]]. [[Gastric]] [[ulcers]] are present mostly at lesser curvature of the [[stomach]] while [[Duodenal]] [[ulcers]] are mostly present at the duodenal bulb. | ||
==Classification== | ==Classification== | ||
===Peptic ulcer=== | ===Peptic ulcer=== | ||
[[Peptic ulcer]] disease may be classified according to location into two subtypes: <ref name="pmid2750129">{{cite journal| author=Belousov AS, Rakitskaia LG, Mamedova LD, Zhakov VP| title=[Pathogenesis and classification of peptic ulcer]. | journal=Vrach Delo | year= 1989 | volume= | issue= 3 | pages= 70-3 | pmid=2750129 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2750129 }} </ref><ref name="pmid22095009">{{cite journal| author=Tytgat GN| title=Etiopathogenetic principles and peptic ulcer disease classification. | journal=Dig Dis | year= 2011 | volume= 29 | issue= 5 | pages= 454-8 | pmid=22095009 | doi=10.1159/000331520 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22095009 }} </ref> | |||
*Gastric [[ulcers]] | |||
*Duodenal [[Ulcer|ulcers]] | |||
=== | === Classification and prevalences of stigmata of recent hemorrhage of peptic ulcer using endoscopy === | ||
{| class="wikitable" | {| class="wikitable" | ||
! colspan=" | ! colspan="3" |Classification and prevalences of stigmata of recent hemorrhage of peptic ulcer using endoscopy* | ||
|- | |- | ||
|Stigmata of [[hemorrhage]] | |||
|Stigmata of hemorrhage | |||
|Forrest classification | |Forrest classification | ||
|Prevalence | |Prevalence | ||
|- | |- | ||
|Active spurting bleeding | |Active spurting [[bleeding]] | ||
|IA | |IA | ||
|12%(spurting+oozing) | |12%(spurting+oozing) | ||
|- | |- | ||
|Active oozing bleeding | |Active oozing [[bleeding]] | ||
|IB | |IB | ||
| | | | ||
|- | |- | ||
|Non-bleeding visible vessel | |Non-[[bleeding]] visible [[vessel]] | ||
|IIA | |IIA | ||
|8% | |8% | ||
|- | |- | ||
|Adherent clot | |Adherent [[clot]] | ||
|IIB | |IIB | ||
|8% | |8% | ||
| Line 73: | Line 42: | ||
|III | |III | ||
|55% | |55% | ||
|} | |||
<small>*Adopted:American college of gasteroenterology<ref name="urlManagement of Patients with Ulcer Bleeding | American College of Gastroenterology">{{cite web |url=https://gi.org/guideline/management-of-patients-with-ulcer-bleeding/ |title=Management of Patients with Ulcer Bleeding | American College of Gastroenterology |format= |work= |accessdate=}}</ref> </small> | |||
==Gastric ulcer== | |||
[[Gastric]] [[ulcer]] is further divided on the basis of location and endoscopic findings: | |||
====Johnson classification==== | |||
*[[Gastric]] [[ulcer]] is further classified into 3 subtypes depending upon their location:<ref name="pmid5845595">{{cite journal |vauthors=Johnson HD |title=Gastric ulcer: classification, blood group characteristics, secretion patterns and pathogenesis |journal=Ann. Surg. |volume=162 |issue=6 |pages=996–1004 |year=1965 |pmid=5845595 |pmc=1477018 |doi= |url=}}</ref><ref name="pmid14058266">{{cite journal |vauthors=BARON JH |title=AN ASSESSMENT OF THE AUGMENTED HISTAMINE TEST IN THE DIAGNOSIS OF PEPTIC ULCER. CORRELATIONS BETWEEN GASTRIC SECRETION, AGE AND SEX OF PATIENTS, AND SITE AND NATURE OF THE ULCER |journal=Gut |volume=4 |issue= |pages=243–53 |year=1963 |pmid=14058266 |pmc=1413442 |doi= |url=}}</ref><ref name="pmid13234346">{{cite journal |vauthors=JOHNSON HD |title=The special significance of concomitant gastric and duodenal ulcers |journal=Lancet |volume=268 |issue=6858 |pages=266–70 |year=1955 |pmid=13234346 |doi= |url=}}</ref> | |||
**Type 1: [[Ulcer]] present at the body of [[stomach]] without involving [[duodenum]], [[pylorus]] or prepyloric region and not associated with hypersecretion of gastric acid | |||
**Type 2: [[Ulcer]] present at the body of [[stomach]] combined with [[duodenum]] and associated with gastric acid hypersecretion | |||
**Type 3: [[:Ulcer]] close to [[pylorus]] and associated with gastric acid hypersecretion | |||
====Sakita classification==== | |||
* Gastric ulcer classification by using endoscopic staging system of Sakita into three stages:<ref name="pmid11085491">{{cite journal| author=Kaneko E, Hoshihara Y, Sakaki N, Harasawa S, Ashida K, Asaka M et al.| title=Peptic ulcer recurrence during maintenance therapy with H2-receptor antagonist following first-line therapy with proton pump inhibitor. | journal=J Gastroenterol | year= 2000 | volume= 35 | issue= 11 | pages= 824-31 | pmid=11085491 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11085491 }}</ref> | |||
** Active | |||
** Healing | |||
** Scarring | |||
{| class="wikitable" | |||
|- | |||
! colspan="2" |ACTIVE STAGE | |||
|- | |||
|A1 | |||
|Surrounding mucosa is found to be edematously swollen and there is no regenerating epithelium seen on [[endoscopy]] | |||
|- | |||
|A2 | |||
|Surrounding mucosa is less edematous, a small amount of regenerating [[epithelium]] is seen at the [[ulcer]] margin | |||
A red halo in the marginal zone, a white slough circle and converging mucosal folds t the [[ulcer]] margin are frequently seen | |||
|- | |||
| colspan="2" style="padding: 5px 5px; background: #F5F5F5;" align="center" | '''HEALING STAGE''' | |||
|- | |||
|H1 | |||
|The white coating is becoming thin and the regenerating [[epithelium]] is extending into the [[ulcer]] base | |||
The gradient between the [[ulcer]] margin and the [[ulcer]] floor is becoming flat | |||
The [[ulcer]] crater is still evident and the margin of the [[ulcer]] is sharp | |||
The diameter of the mucosal defect is about one-half to two thirds that of A1 | |||
|- | |||
|H2 | |||
|The defect is smaller than in H1 and the regenerating epithelium covers most of the ulcer floor. The area of white coating is about a quarter to one-third that of A1 | |||
|- | |||
| colspan="2" style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''SCARRING STAGE''' | |||
|- | |||
|S1 | |||
|The regenerating epithelium completely covers the floor of the [[Ulcer|ulcer]] | |||
The white coating has disappeared | |||
Initially, the regenerating region is markedly red but upon close observation, many capillaries can be seen and this is called ‘‘red scar’’ | |||
|- | |||
|S2 | |||
|In several months to a few years, the redness is reduced to the color of the surrounding mucosa and this is called ‘‘white scar’’ | |||
|} | |} | ||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
{{WikiDoc Help Menu}} | |||
{{WikiDoc Sources}} | |||
[[Category:Gastroenterology]] | [[Category:Gastroenterology]] | ||
Latest revision as of 23:37, 29 July 2020
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2017 ACG Guidelines for Peptic Ulcer Disease |
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Guidelines for the Indications to Test for, and to Treat, H. pylori Infection |
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Guidlines for factors that predict the successful eradication when treating H. pylori infection |
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Guidelines to document H. pylori antimicrobial resistance in the North America |
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Guidelines for when to test for treatment success after H. pylori eradication therapy |
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Guidelines for penicillin allergy in patients with H. pylori infection |
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Peptic ulcer classification On the Web |
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American Roentgen Ray Society Images of Peptic ulcer classification |
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Risk calculators and risk factors for Peptic ulcer classification |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Manpreet Kaur, MD [2]
Overview
Peptic ulcer disease may be classified into two types based on the location within the gastrointestinal tract. gastric ulcer and duodenal ulcer. Gastric ulcers are present mostly at lesser curvature of the stomach while Duodenal ulcers are mostly present at the duodenal bulb.
Classification
Peptic ulcer
Peptic ulcer disease may be classified according to location into two subtypes: [1][2]
Classification and prevalences of stigmata of recent hemorrhage of peptic ulcer using endoscopy
| Classification and prevalences of stigmata of recent hemorrhage of peptic ulcer using endoscopy* | ||
|---|---|---|
| Stigmata of hemorrhage | Forrest classification | Prevalence |
| Active spurting bleeding | IA | 12%(spurting+oozing) |
| Active oozing bleeding | IB | |
| Non-bleeding visible vessel | IIA | 8% |
| Adherent clot | IIB | 8% |
| Flat pigmented spot | IIC | 16% |
| Clean base | III | 55% |
*Adopted:American college of gasteroenterology[3]
Gastric ulcer
Gastric ulcer is further divided on the basis of location and endoscopic findings:
Johnson classification
- Gastric ulcer is further classified into 3 subtypes depending upon their location:[4][5][6]
- Type 1: Ulcer present at the body of stomach without involving duodenum, pylorus or prepyloric region and not associated with hypersecretion of gastric acid
- Type 2: Ulcer present at the body of stomach combined with duodenum and associated with gastric acid hypersecretion
- Type 3: Ulcer close to pylorus and associated with gastric acid hypersecretion
Sakita classification
- Gastric ulcer classification by using endoscopic staging system of Sakita into three stages:[7]
- Active
- Healing
- Scarring
| ACTIVE STAGE | |
|---|---|
| A1 | Surrounding mucosa is found to be edematously swollen and there is no regenerating epithelium seen on endoscopy |
| A2 | Surrounding mucosa is less edematous, a small amount of regenerating epithelium is seen at the ulcer margin
A red halo in the marginal zone, a white slough circle and converging mucosal folds t the ulcer margin are frequently seen |
| HEALING STAGE | |
| H1 | The white coating is becoming thin and the regenerating epithelium is extending into the ulcer base
The gradient between the ulcer margin and the ulcer floor is becoming flat The ulcer crater is still evident and the margin of the ulcer is sharp The diameter of the mucosal defect is about one-half to two thirds that of A1 |
| H2 | The defect is smaller than in H1 and the regenerating epithelium covers most of the ulcer floor. The area of white coating is about a quarter to one-third that of A1 |
| SCARRING STAGE | |
| S1 | The regenerating epithelium completely covers the floor of the ulcer
The white coating has disappeared Initially, the regenerating region is markedly red but upon close observation, many capillaries can be seen and this is called ‘‘red scar’’ |
| S2 | In several months to a few years, the redness is reduced to the color of the surrounding mucosa and this is called ‘‘white scar’’ |
References
- ↑ Belousov AS, Rakitskaia LG, Mamedova LD, Zhakov VP (1989). "[Pathogenesis and classification of peptic ulcer]". Vrach Delo (3): 70–3. PMID 2750129.
- ↑ Tytgat GN (2011). "Etiopathogenetic principles and peptic ulcer disease classification". Dig Dis. 29 (5): 454–8. doi:10.1159/000331520. PMID 22095009.
- ↑ "Management of Patients with Ulcer Bleeding | American College of Gastroenterology".
- ↑ Johnson HD (1965). "Gastric ulcer: classification, blood group characteristics, secretion patterns and pathogenesis". Ann. Surg. 162 (6): 996–1004. PMC 1477018. PMID 5845595.
- ↑ BARON JH (1963). "AN ASSESSMENT OF THE AUGMENTED HISTAMINE TEST IN THE DIAGNOSIS OF PEPTIC ULCER. CORRELATIONS BETWEEN GASTRIC SECRETION, AGE AND SEX OF PATIENTS, AND SITE AND NATURE OF THE ULCER". Gut. 4: 243–53. PMC 1413442. PMID 14058266.
- ↑ JOHNSON HD (1955). "The special significance of concomitant gastric and duodenal ulcers". Lancet. 268 (6858): 266–70. PMID 13234346.
- ↑ Kaneko E, Hoshihara Y, Sakaki N, Harasawa S, Ashida K, Asaka M; et al. (2000). "Peptic ulcer recurrence during maintenance therapy with H2-receptor antagonist following first-line therapy with proton pump inhibitor". J Gastroenterol. 35 (11): 824–31. PMID 11085491.