Peptic Ulcer
Disease (PUD)
Epidemiology and Etiology:
- Middle aged to
older
- M > F
- Risk factors:
- H. pylori infection (present in virtually all
cases of duodenal and 70% of gastric ulcers) (only 10-20% infected
develop ulcers)
- Inducing inflammation
and cytokines
- Damage of
surface epithelial cells
- Enhances acid
secretion
- Impairs bicarbonate
production
- Thrombotic occlusion of surface capillaries
promoted by a bacterial platelet-activating factor
- leakage
- impaired blood
flow / Ischemia / shock
- Cigarettes
- Severe systemic
stress
- Drugs:
- NSAIDs
- ASA
- Corticosteroids
(high dose, repeated)
- Toxins:
- delayed gastric emptying
- gastric
hyperacidity
- Zollinger-Ellsion syndrome
- Alcoholic cirrhosis
- COPD
- Hypercalcemia (stimulates acid production):
- Chronic renal
failure
- Hyperparathyroidism
- Psychologic stress and personality
- Pathogenesis:
- Imbalance between
defense mechanisms and damaging forces
- Mucosal defense:
- Mucous secretion
- Bicarbonate secretion
- Mucosal blood
flow
- Apical surface
membrane transport
- Epithelial regenerative
capacity
- Prostaglandin
elaboration
- Damaging forces:
Common sites:
- duodenum
- anterior wall
- a few
centimeters from the pylorus
- stomach (antrum usually)
- GE junction
(reflux)
- Gastrojejunostomy margins
- Within or adjacent
to Meckel diverticulum
Gross features:
- solitary usually
- <4cm
- round to oval
- sharply punched
out defect
- relatively
straight walls
- margin flush with surrounding
mucosa or slightly elevated (heaping up is rare)
- base is smooth and
clean
- may see spokelike mucosal folds radiating from the ulcer
(from fibrosis)
- edematous and erythematous
mucosa surrounding
Histologic features:
- ulcer – breach in the mucosa extending into the submucosa or deeper
- layers of an ulcer
(superficial to deep):
- necrotic debris
- acute
inflammation
- granulation
tissue
- fibrosis
- vessels
within may be thrombosed
- concurrent chronic
gastritis almost always
Immunophenotype:
Marker:
|
Sensitivity:
|
Specificity:
|
|
|
|
Molecular features:
Other features:
- treatment of H. pylori helps heal and prevent further ulcers
- clinical:
- epigastric
pain (may be chest or back pain in some cases)
- gnawing,
burning, aching
- worse
at night
- 1-3h
after meals during the day
- relieved
by alkalis
- relieved
by food
- nausea
/ vomiting
- bloating
- belching
- weight
loss
- anemia
- complications:
- bleeding
- perforation
- obstruction
(edema/scarring)
References: