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
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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