PEPTIC ULCER

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PEPTIC ULCER ????? ???????????? ??? MD
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An excoriated segment of the GI mucosa,
typically in the stomach (gastric ulcer) or first
few centimeters of the duodenum (duodenal ulcer),
which penetrates through the muscularis mucosa
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Epidemiology

• ??????,?10??????????
• ???????,?????
• ????,DU??GU

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Etiology

• H. pylori
• NSAID
• Gastric acid and pepsin
• Genetic factor
• Others
• Peptic ulcer related disease

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Etiology
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H. pylori??

• ??????????????
• ???H. pylori????????
• (DU90-100, GU80-90)
• b. ??H. pylori???????
• c. ??H. pylori??????????(50-70 5 )

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Leaking Roof Hypothesis
????
??
?
??? ???
??
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(No Transcript)
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NSAID?????
local effect
NSAID
?????
?????
????
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NSAID?????
Systemic effect
NSAID
COX-2
COX-1
Inflammatory reaction
??PGE??
????????? ????
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Gastric Acid and Pepsin

• ?????????????????
• No acid, no ulcer
• ??????????H.pylori??
• GU???????????????????,??GU???????,?????,?????????
  ???,??????

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attack factor ??????? NSAID ??/???? ??
defense factor ??-?????? ???? ???? ????
??????
??????
??????
?????? ??????
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Clinical Manifestation

• Chronic
• Periodic
• rhythmic
• Sign tenderness point below xiphoid
  process

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Special types

• Complex ulcer
• Pyloric canal ulcer
• Postbulbar ulcer
• Macrosis ulcer
• Peptic ulcer in aged
• Silence ulcer

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???????

• ????DU?GU??
• ????????????,???,?????????
• ??????????????,???????,???
• ????gt2cm,???????,??????
• ?????????????,???,?????
• ????????15????,????,?????????

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Gastroscope and Biopsy

• ?????????
• ??????????????H.pylori??
• ???????????

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? ? ? ? ? ? ? ?
???(A?) A1? ???????????
???(A?) A2? ???????????????
???(H?) H1? ??????????????????
???(H?) H2? ???????????????
???(S?) S1? ?????????????
???(S?) S2? ???????
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(No Transcript)
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Barium Meal Examination

• ??????????????????
• ?????? niche sign
• ???????????????????????????

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H. pylori Detection

• ??????????????,??????
• ??????????????????????
• ????13C,14C ???????????(???Hp??,???Hp-IgG??)

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Diagnosis

• Important clue Chronic, Periodic, rhythmic
  pain of upper abdominal
• Final diagnosis gastroscope, Barium meal
  examination

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Differential Diagnosis
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• functional dyspepsia
• chronic cholecystitis and cholelithiasis
• gastric cancer
• pancreatic cancer
• Zollinger-Ellison syndrome

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Functional Dyspepsia

• ???????????????????3????
• ?????????????????????
• ????????????????????

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?????????????
??? ???? ????
?? ?? ????        ???? ????  X?????       ???? ????? ?? ??????? ????? ?????,????????,????????  ????? ???????,?????? ????lt2.5cm,???,????????????????,??????? ???????,???,???,?????,????????,????????? ??????? ?? ?????? ?????? ????(???)??,????????,?????? ???? ?????  ???gt2.5cm,???,????????????????,????,??????????????? ???????,?????,??????,???,???????????????,??????????
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Zollinger-Ellison Syndrome

• ???ß???,???(lt1cm),????
• ???BAOgt15mmol/h MAOgt60mmol/h
• BAO/MAOgt60
• ??????????Gastringt200pg/ml
• ???????,???????
• diarrhea

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Complication

• Bleeding
• Perforation
• Pyloric obstruction
• Canceration

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(No Transcript)
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General Treatment

• Avoid exertion
• Stop smoking and drinking
• Less NSAID

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Drugs

• ???
• ?????
• ???

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?????????????
???
????
????
M
G
H2
???
K
PPI
PP
H
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H2 Receptor Antagonist
???? ? ? ?DU??(4W)

Cimetidine 400mg bid or 800mg qn 80
Ranitidine 150mg bid or 300mg qn 90
Famotidine 20mg bid or 40mg gn 94
Nizatidine 150mg bid or 300mg qn gt90
roxatidine 75mg bid or 150mg qn 93.5
???????????????????????????????
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Proton Pump Inhibitor

• ??????????????H--KATP
• ?,?????H????K?
• ??,???????????
• ???Hp????????
• ???????????????????
• ??????????
• ? ? ???????????????
• ???????

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Mucosa Protectant

• Sucralfate ???
• colloidal bismuth subcitrate
• ???????
• Misoprostol ?????

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Antiacid

• ???????????
• ???????????????????
• ? (???)??-????????
• ??????

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H. pylori?????

• Hp????? ?? ??
  ??? ???
• ????? v
• ?????MALT??? v
• ?????? v
• ???????
  v
• ??????????NSAID v
• ??????
  v
• ????
  v
• ?????????????
  v
• ???????
  v
• ?????????
  v

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??????

• ?????????
• ????
• ???????
• ???????
• ???????????

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Summary

• EtiologyH. pylori, NSAID, gastric acid and
  pepsin, genetic factor and others
• Clinical Manifestation Chronic, Periodic,
  rhythmic pain of upper abdominal
• Diagnosishistory, gastroscope, Barium meal
  examination
• Treatment PPI, mucosa protectant, Hp radical
  cure, surgery
• ConceptZollinger-Ellison syndrome, complex
  ulcer, postbulbar ulcer, functional dyspepsia

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