Chapter 24.Stomach and Duodenum Diseases
Chapter 24. Stomach and Duodenum Diseases
Sections 3. Peptic Ulcer Diseases ★★★★★.3.1Duodenalulcer·3.2Gastriculcer·3.3 Hemorrhage frompeptic ulcer· 3.4 Pyloric obstruction dueto peptic ulcer·3.5Perforatedpepticulcer
Sections 3. Peptic Ulcer Diseases ★★★★★ • 3.1 Duodenal ulcer • 3.2 Gastric ulcer • 3.3 Hemorrhage from peptic ulcer • 3.4 Pyloric obstruction due to peptic ulcer • 3.5 Perforated peptic ulcer
Pathogenesis HelicobacterpyloriinfectionNational InstitutesofHealthConsensusPanelRecommendationsfor Helicobacterpylori Treatment.90%ofDUsandPatientswithactivePUDwhoareH.pylori-positiveapproximately75%ofGUsare.Use of NSAiDs shouldnot altertreatmentassociatedwithH.pyloriDocument eradication in those with complicationsinfection.Ulcer patients in remission who are H.Pylori-positive,including.Whenthisorganismispatients on maintenance Hz receptor antagonist therapyH.pylori-positivepatientswithMALTlymphomaeradicatedaspartofulcerControversial issuesinH.Pylori-positivepatients:treatment,ulcerrecurrenceis.First-degree relativesof gastriccancerpatientsextremelyrare.Immigrants from countries with high prevalence of gastriccancerIndividuals withgastric cancerprecursor lesions (intestinalmetaplasia)·Non-ulcer dyspepsia patients who insist on eradication(benefitversusrisk)Patients on long-termantisecretorytherapyforrefluxdisease
Pathogenesis_Helicobacter pylori infection • 90% of DUs and approximately 75% of GUs are associated with H. pylori infection. • When this organism is eradicated as part of ulcer treatment, ulcer recurrence is extremely rare. National Institutes of Health Consensus Panel Recommendations for Helicobacter pylori Treatment
Pathogenesis_Helicobacter pyloriinfection·Inthecaseofduodenal andgastric ulcers,Helicobacterpylorimustcolonizeand weaken the mucosa before acid is able to do the damage,andtherapydirected against thisorganismhas a moredefinitiveeffectonthedisease.PEPTICULCERHelicobacterpyloriThebacteriacolonizedamage protectivethestomachmucosamucuslayeMucusAcid passes throughlayerweakenedmucus layecausing an ulcer6o0EpithelialConnectivetissuecells
Pathogenesis_Helicobacter pylori infection • In the case of duodenal and gastric ulcers, Helicobacter pylori must colonize and weaken the mucosa before acid is able to do the damage, and therapy directed against this organism has a more definitive effect on the disease
Pathogenesis_Helicobacter pyloriinfectionFOCALHELICOBACTERPYLORIGASTRITIS.PatchyHELICOBACTERPYLORIGASTRITIS.Mildsuperficialgastritisresults in erythemaandprominenceoftheareasofinflammationintheproximalgastricbodyareareaegastricae(asseen underwater)welldemarcatedbythesurroundingatrophicmucosa
Pathogenesis_Helicobacter pylori infection HELICOBACTER PYLORI GASTRITIS. Mild superficial gastritis results in erythema and prominence of the areae gastricae (as seen underwater). FOCAL HELICOBACTER PYLORI GASTRITIS. Patchy areas of inflammation in the proximal gastric body are well demarcated by the surrounding atrophic mucosa