PEPTIC UlCERS

• Chronic, usually solitary lesion (80%) occurring at any level of Gl tract exposed to acid-peptic juices
• Most commonly 1st portion duodenum (~80%), antrum of stomach (~20%), Barrett's esophagus, Meckel's
• Remitting and relapsing course; male: female =3:1 (duodenal); 1.5-2:1 (gastric); pain after eating
• 50% <2 cm, 75% <3 cm, 10% >4 cm
• Oval, sharply delimited defect with tendency for overhanging mucosal margins, especially proximally
• Minimal if any heaping up of margins (common in carcinoma)
• Gastric folds radiate out from ulcer
• Nearly all patients have concurrent chronic antral gastritis (e.g., Helicobacter pylori); those who don't are usually habitual aspirin users
• Fatal in ~5%: 70% caused by perforation, 10% due to bleeding
  • Duodenal:
    • Genetic influences appear to be involved
    • Increased incidence in alcoholic cirrhosis, chronic renal failure, chronic obstructive pulmonary disease (COPD), hyperparathyroidism
    • Increase in both the basal and stimulated level of acid secretion, and more rapid gastric emptying are common Anterior wall more commonly than posterior
  • Gastric:
    • Genetic influences do not appear to be involved
    • Low to normal acidity; probably abnormal mucosal resistance
    • Usually lesser curve
    • 1 -3% will develop gastric carcinoma