Peptic ulcer classification
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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, 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.
Classification
Peptic ulcer
- Peptic ulcer disease may be classified according to location into two subtypes [1][2]
- Gastric ulcer
- Duodenal ulcer
Gastric ulcer
Gastric ulcer is further divided on the basis of location and endoscopic findings:
Based upon the location of ulcer
- Gastric ulcer is further classified into 3 subtypes depending upon their location by the Johnson[3]
- Type 1:Ulcer present at the body of stomach without involving duodenum ,pyrolus or prepyrolic region
- Type 2:Ulcer present at the body of stomach combined with and probably seconadary to an ulcer or its scar in th duodenum or at pyrolus
- Type 3:Ulcer close to pyrolus
Based upon endoscopic findings
| Gastric ulcer classification by using endoscopic staging system of Sakita into three stages :Active ,Healing and Scarring:[4] | |
|---|---|
| ACTIVE STAGE | |
| A1 | Surrounding mucosa is found to be edematously swollen and there is no regeneration epithelium seen in endoscopy |
| A2 | surrounding edema has decreased, a small amount of regenerating epithelium is seen in the ulcer margin. A red halo in the marginal zone and a white slough circle and converging mucosal folds in the ulcer margin are frequently seenn |
| 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 ulcer. The white coating has disappeared. Initially, the regenerating region is markedly red. Upon close observation, many capillaries can be seen. This is called ‘‘red scar’’ |
| S2 | In several months to a few years, the redness is reduced to the color of the surrounding mucosa. This is called ‘‘white scar’’ |
| Classification and prevalences of stigmata of recent hemorrhage 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[5]
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.
- ↑ Johnson HD (1965). "Gastric ulcer: classification, blood group characteristics, secretion patterns and pathogenesis". Ann. Surg. 162 (6): 996–1004. PMC 1477018. PMID 5845595.
- ↑ 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.
- ↑ "Management of Patients with Ulcer Bleeding | American College of Gastroenterology".