Peptic ulcer natural history: Difference between revisions
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*'''Bleeding''' is the commonest complication. | *'''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>. | **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>. | ||
**Bleeding occurs when the ulcer erodes one of the blood vessels around the stomach. | **Bleeding occurs when the ulcer erodes one of the blood vessels around the stomach.<ref name="pmid22095016">{{cite journal |vauthors=Milosavljevic T, Kostić-Milosavljević M, Jovanović I, Krstić M |title=Complications of peptic ulcer disease |journal=Dig Dis |volume=29 |issue=5 |pages=491–3 |year=2011 |pmid=22095016 |doi=10.1159/000331517 |url=}}</ref> | ||
*'''Perforation''' | *'''Perforation''' | ||
**Erosion of the gastro-intestinal wall by the ulcer leads to spillage of stomach or intestinal content into abdominal cavity leading to catastrophic consequences. | **Erosion of the gastro-intestinal wall by the ulcer leads to spillage of stomach or intestinal content into abdominal cavity leading to catastrophic consequences. | ||
Revision as of 00:54, 17 November 2017
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Peptic ulcer Microchapters |
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Diagnosis |
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Treatment |
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Surgery |
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Case Studies |
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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 evaluation and testing of H. pylori antibiotic resistance |
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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 natural history On the Web |
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American Roentgen Ray Society Images of Peptic ulcer natural history |
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Risk calculators and risk factors for Peptic ulcer natural history |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ;Associate Editor(s)-in-Chief: Manpreet Kaur, MD [2]
Overview
Peptic ulcers tend to come back if untreated. Cure rates are high and recurrence is low, if patient is compliant to treatment.
Natural History
- The infection of Helicobacter pylori , common cause of peptic ulcer disease is acquired usually during the childhood, mainly in those who have low socioeconomic status, increased number of siblings and similar infection in the mother[1][2][3]
- The duodenal ulcer occurs in second to fifth decade of life. where as gastric ulcer occurs in the 4th decade of life.
- Peptic ulcer disease starts with symptoms such as episodic epigastric pain, indigestion, bloating.
- Without treatment, the patient will develop symptoms of perforation like severe abdominal pain. Chronic infection leads to gastric atrophy, gastric metaplasia and ultimately leads to gastric cancer and MALT lymphoma.[4]
Complications
Acute complications :
- Bleeding is the commonest complication.
- Perforation
- Erosion of the gastro-intestinal wall by the ulcer leads to spillage of stomach or intestinal content into abdominal cavity leading to catastrophic consequences.
- 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.
- Penetration is also a form of perforation, when the ulcer continues into adjacent organs such as liver and pancreas.[7][8]
- Obstruction
- Occurs as a result of stricture and scarring narrowing in the duodenum leading to gastric outlet obstruction.
Chronic complications:
Chronic Helicobacter pylori infection leads to
- Gastric cancer
- MALT cell lymphoma
- Iron deficiency anemia
- Idiopathic thrombocytopenic purpura
Prognosis
References
- ↑ Opekun AR, Gilger MA, Denyes SM, Nirken MH, Philip SP, Osato MS, Malaty HM, Hicks J, Graham DY (2000). "Helicobacter pylori infection in children of Texas". J. Pediatr. Gastroenterol. Nutr. 31 (4): 405–10. PMID 11045838.
- ↑ Parkinson AJ, Gold BD, Bulkow L, Wainwright RB, Swaminathan B, Khanna B, Petersen KM, Fitzgerald MA (2000). "High prevalence of Helicobacter pylori in the Alaska native population and association with low serum ferritin levels in young adults". Clin. Diagn. Lab. Immunol. 7 (6): 885–8. PMC 95979. PMID 11063492.
- ↑ Malaty HM, El-Kasabany A, Graham DY, Miller CC, Reddy SG, Srinivasan SR, Yamaoka Y, Berenson GS (2002). "Age at acquisition of Helicobacter pylori infection: a follow-up study from infancy to adulthood". Lancet. 359 (9310): 931–5. doi:10.1016/S0140-6736(02)08025-X. PMID 11918912.
- ↑ Kusters JG, van Vliet AH, Kuipers EJ (2006). "Pathogenesis of Helicobacter pylori infection". Clin. Microbiol. Rev. 19 (3): 449–90. doi:10.1128/CMR.00054-05. PMC 1539101. PMID 16847081.
- ↑ Cullen DJ, Hawkey GM, Greenwood DC; et al. (1997). "Peptic ulcer bleeding in the elderly: relative roles of Helicobacter pylori and non-steroidal anti-inflammatory drugs". Gut. 41 (4): 459–62. PMID 9391242.
- ↑ Milosavljevic T, Kostić-Milosavljević M, Jovanović I, Krstić M (2011). "Complications of peptic ulcer disease". Dig Dis. 29 (5): 491–3. doi:10.1159/000331517. PMID 22095016.
- ↑ "Peptic Ulcer: Peptic Disorders: Merck Manual Home Edition". Retrieved 2007-10-10.
- ↑ "Peptic Ulcer: Peptic Disorders: Merck Manual Home Edition". Retrieved 2007-10-10.