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Chapter IV/4: Gastric Ulcer
Hagymási Krisztina
IV/4.1: Introduction
Gastric ulcer is a sharply demarcated defect of the mucous membrane in the stomach penetrating the muscular layer of the mucosa. It is most commonly located at the angular lesser curvature, less frequent in the subcardiac region of the fundus, as well as in a segment of 2 to 3 cm in front of the cardia. Its development is a complicated process consisting of several steps and characterized by a disordered balance between the aggressive factors (pepsin, gastric acid) and the protective processes of the mucosa.
The most important causative factor is the Gram negative bacterium Helicobacter pylori (H. pylori) . In Hungary 60 to 65% of the adult population are infected by H. pylori. A peptic ulcer develops in 10 to 15% of infected individuals during their lifetime. An etiologic role of H. pylori has been demonstrated in 80% and 90% of gastric and duodenal ulcers respectively. In Hungary the taking of non-steroidal anti-inflammatory drugs (NSAID) is the underlying cause in 20% of patients with peptic ulcer . A peptic ulcer develops in 15 to 30% of patients taking NSAIDs. The risk of developing an ulcer is increased by 1.79, 4.85, and 6.13 by H. pylori infection, taking of NSAID, and both of them, respectively.
In patients with no H. pylori infection and not taking NSAID, there may be several other underlying diseases (Zollinger-Ellison syndrome, high dose upper abdominal irradiation, Crohn’s disease, amyloidosis, tuberculosis, sarcoidosis, eosinophilic gastroenteritis, lymphoma, Henoch-Schönlein purpura, cytomegalovirus, herpes simplex or Helicobacter heilmannii infections, stress , or an unknown cause [idiopathic ulcer]). The aggressive factors are strengthened by smoking, consumption of great quantities of alcohol, taking of medicines (most commonly NSAIDs or bisphosphonates, potassium chloride, immunosuppressive therapy). Stress alone is insufficient for ulcer development, but it enhances the process. Peptic ulcer presents a significant financial burden for the health care. In the United States the yearly budget of care amounts to 5.65 billion dollars what includes the costs of missed time of work, as well as the expenses of inpatient and outpatient care.
The chapter structure
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IV/4.1: Introduction
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IV/4.3: Course
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IV/4.5: Diagnostics beyond imaging
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IV/4.6: Differential diagnosis
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References
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Simon L: Pepticus fekélybetegség. In: A belgyógyászat alapjai (Szerk.: Tulassay Zs), Medicina Budapest, 2011: 850-857.
Hagymási K, Tulassay Zs: Peptikus fekély: tények és kérdések-2010. Orv Hetil 2010, 26: 1054-1061.
A fekélybetegség (a nyombél- és a gyomorfekély) ellátási protokollja. In: Gasztroenterológiai Útmutató (Szerk.: Tulassay Zs), Klinikai Irányelvek Kézikönyve, Medition Kiadó, Budapest, 2007: 76-83.
Simon L: Peptikus fekélyek és peptikus fekélybetegség. In: Gasztroenterológia, Medicina Budapest, 2011: 231-250.
Ramakrishnan K, Salinas RC: Peptic ulcer diseases. Am Fam Physician 2007, 76: 1005-1012.
Lew E: Peptic ulcer disease. In: Current Diagnosis, Treatment: Gastroenterology, Hepatology, Endoscopy (Ed.: Greenberger NJ, Blumberg RS, Burakoff R), McGraw Hill Medical, 2009: 175-183.
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