Peptic ulcer overview: Difference between revisions
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==Pathophysiology== | ==Pathophysiology== | ||
A major causative factor (60% of [[gastric]] and 90% of [[duodenal]] [[ulcers]]) is chronic [[inflammation]] due to [[Helicobacter pylori]] that colonize the antral [[mucosa]]. The [[immune system]] is unable to clear the [[infection]], despite the appearance of [[antibodies]]. Thus, the [[bacterium]] can cause a [[Gastritis|chronic active gastritis]] (type B gastritis), resulting in a defect in the regulation of [[gastrin]] production and [[gastrin]] secretion is increased. [[Gastrin]] stimulates the production of [[gastric acid]] by [[Parietal cell|parietal cells]]. The [[acid]] erodes the [[mucosa]] and causes the [[ulcer]]. Another major cause is the use of [[NSAIDs]] The [[gastric mucosa]] protects itself from [[gastric acid]] with a layer of [[mucus]], the secretion of which is stimulated by certain [[Prostaglandin|prostaglandins]]. [[NSAIDs]] block the function of cyclooxygenase 1 (cox-1), which is essential for the production of these [[Prostaglandin|prostaglandins]]. | |||
==Causes== | ==Causes== | ||
Revision as of 20:54, 1 December 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 overview On the Web |
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American Roentgen Ray Society Images of Peptic ulcer overview |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ;Associate Editor(s)-in-Chief: Manpreet Kaur, MD [2]
Overview
A peptic ulcer'[1] is an ulcer of an area of the gastrointestinal tract that is usually acidic and thus extremely painful. 80% of ulcers are associated with Helicobacter pylori, a spiral-shaped bacterium that lives in the acidic environment of the stomach, however only 20% of those cases go to a doctor (for it is not a dangerous case if caught in time and can be treated with surgery). Ulcers can also be caused or worsened by drugs such as Aspirin and other NSAIDs. Contrary to general belief, more peptic ulcers arise in the duodenum (first part of the small intestine, just after the stomach) than in the stomach. About 4% of stomach ulcers are caused by a malignant tumor, so multiple biopsies are needed to make sure. Duodenal ulcers are generally benign.
Historical Perspective
Classification
Peptic ulcer disease may be classified into two types based on the location, gastric ulcer and duodenal ulcer. Gastric ulcers are present mostly at lesser curvature of the stomach. Duodenal ulcers are mostly present at the duodenal bulb.
Pathophysiology
A major causative factor (60% of gastric and 90% of duodenal ulcers) is chronic inflammation due to Helicobacter pylori that colonize the antral mucosa. The immune system is unable to clear the infection, despite the appearance of antibodies. Thus, the bacterium can cause a chronic active gastritis (type B gastritis), resulting in a defect in the regulation of gastrin production and gastrin secretion is increased. Gastrin stimulates the production of gastric acid by parietal cells. The acid erodes the mucosa and causes the ulcer. Another major cause is the use of NSAIDs The gastric mucosa protects itself from gastric acid with a layer of mucus, the secretion of which is stimulated by certain prostaglandins. NSAIDs block the function of cyclooxygenase 1 (cox-1), which is essential for the production of these prostaglandins.
Causes
Differentiating Peptic ulcer overview from Other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications, and Prognosis
Natural History
Peptic ulcers tend to come back if untreated. Cure rates are high and recurrence is low, if patient is compliant to treatment.
Complications
Prognosis
Diagnosis
Diagnostic Criteria
History and Symptoms
Physical Examination
Laboratory Findings
Imaging Findings
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.
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.
Other diagnostic studies
Treatment
Medical Therapy
Surgery
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.
Prevention
References
- ↑ "GI Consult: Perforated Peptic Ulcer". Retrieved 2007-08-26.