Peptic ulcer natural history
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{CMG}} ;Associate Editor(s)-in-Chief: Manpreet Kaur, MD [1]
Overview
Helicobacter pylori infection is a common cause of peptic ulcer disease which is acquired usually during childhood but presents in second to fifth decade of life. Patient presents with episodic epigastric pain, indigestion, bloating,hematemesis and melena. If not treated, patients can develop complications like bleeding, perforation, obstruction or stricture. Chronic infection of helicobacter pylori leads to gastric cancer,, MALT lymphoma,iron deficiency anemia,Idiopathic thrombocytopenic purpura. Peptic ulcers tend to recur if left untreated. Prognosis is good if the eradication therapy of Helicobacter pylori is taken.The recurrence rate of patients with peptic ulcer disease is less than 20%.
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
- Perforation is most common occur at the duodenal bulb (62%), followed by the pyloric region (20%), and the gastric body. (18%)
- Erosion of the gastro-intestinal wall by the ulcer leads to spillage of stomach or intestinal content into abdominal cavity leading to fatal 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:
Prognosis
- Prognosis is good if the eradication therapy of Helicobacter pylori is taken
- The recurrence rate of patients with peptic ulcer disease is less than 20%
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.
- ↑ 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.
- ↑ 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.
- ↑ "Peptic Ulcer: Peptic Disorders: Merck Manual Home Edition". Retrieved 2007-10-10.
- ↑ "Peptic Ulcer: Peptic Disorders: Merck Manual Home Edition". Retrieved 2007-10-10.