Peptic ulcer
Gastric peptic ulcer
Updated: 02/21/2021
© Jun Wang, MD, PhD
General features
- Chronic mucosal ulceration in duodenum or stomach
- Associated with Helicobacter pylori infection, NSAID use, Zollinger-Ellison, ischemia, bile/pancreatic juice reflux
- Alcohol, smoking, COPD, and corticosteroids use may worsen condition and impair healing
- Hyperacidity uncommon
- Mortality uncommon, but markedly elevated if perforated
Pathogenesis
- Imbalance between mucosal defense mechanisms and the damaging forces
- Helicobacter pylori infection: CagA, VacA, Urease, Adhesin
- NSAID: inhibition of COX dependent prostaglandins E2 and I2 synthesis
Clinical presentations
- Epigastric pain
- Duodenal ulcer: worst at night, 1-3 hours after meals
- Gastric ulcer: food provoked
- Most common at antrum, lesser curvature
- Commonly with coexisting ulcer in first part of duodenum
- May cause bleeding, gastric outlet obstruction, perforation, etc
Key pathological features
- Sharply punched out defect with straight walls
- The ulcer base is smooth and contains only granulation tissue
- NO evidence of malignancy
Diagnosis
- Biopsy to rule out malignancy
Treatment
- H2 blockers, proton pump inhibitors, antibiotics for H Pylori, or surgery if failed to achieve hemostasis
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