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Peptic ulcer disease: Difference between revisions
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Peptic ulcer disease (PUD) refers to the presence of peptic ulcers in the stomach and/or duodenum. Duodenal ulcers are approx 3 times more common than gastric ulcers. In virtually all cases, patients with PUD either have H. pylori infection and/or use NSAIDs long-term. Few people develop PUD without either of these risk factors. | '''Peptic ulcer disease''' (PUD) refers to the presence of peptic ulcers in the stomach and/or duodenum. '''Duodenal ulcers''' are approx 3 times more common than '''gastric ulcers'''. In virtually all cases, patients with PUD either have H. pylori infection and/or use NSAIDs long-term. Few people develop PUD without either of these risk factors. | ||
These ulcers can cause pain or [[Gastrointestinal bleeding|GI bleeding]]. | |||
In addition to H. pylori and NSAIDs, there are multiple other “supportive” risk factors. These include smoking, alcohol, steroid use, and stress. Severe stress like trauma, burns and surgery may predispose to PUD. These ulcers sometimes have special names: ''Curling-ulcus'' after severe burn injury, and ''Cushing-ulcus'' after CNS injury. | In addition to H. pylori and NSAIDs, there are multiple other “supportive” risk factors. These include smoking, alcohol, steroid use, and stress. Severe stress like trauma, burns and surgery may predispose to PUD. These ulcers sometimes have special names: ''Curling-ulcus'' after severe burn injury, and ''Cushing-ulcus'' after CNS injury. | ||
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|Bleeding, perforation, penetration, scarring formation | |Bleeding, perforation, penetration, scarring formation | ||
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== Classification == | |||
Peptic ulcers are classified according to the Forrest classification. It’s based on the ulcer’s endoscopic morphology and is used to guide whether patients require inpatient care or not. | |||
* Stage I – active haemorrhage | |||
* Stage II – evidence of recent haemorrhage | |||
* Stage III – clean-based ulcer | |||
The risk of recurring haemorrhage is highest in stage I and lowest in stage III. Forrest I – IIb is high risk and require inpatient treatment, while Forrest IIc – III is low risk and can be treated outpatient. | |||
== Clinical features == | == Clinical features == | ||
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== Complications == | == Complications == | ||
Peptic ulcers may bleed, obstruct the gastric outlet, or perforate. Perforation may lead to peritonitis. | Peptic ulcers may [[Gastrointestinal bleeding|bleed]], obstruct the gastric outlet, or perforate. Perforation may lead to [[peritonitis]]. | ||
== Treatment == | == Treatment == | ||