内科学课件26 Peptic ulcer disease (PUD)讲解材料.pptVIP

Peptic Ulcer Disease (PUD) Zhong Liang Hua Shan Hospital Definition A circumscribed ulceration of the gastrointestinal mucosa occurring in areas exposed to acid and pepsin and most often caused by Helicobacter pylori infection. (Uphold Graham, 2003) Location Esophagus Stomach Pylorus Duodenum Small intestine Anastomotic stoma Peptic ulcers:Gastric and Duodenal PUD Demographics Higher prevalence in developing countries H. Pylori is sometimes associated with socioeconomic status and poor hygiene In the US: Lifetime prevalence is ~10%. PUD affects ~4.5 million annually. Hospitalization rate is ~30 pts per 100,000 cases. Mortality rate has decreased dramatically in the past 20 years approximately 1 death per 100,000 cases Gastric Ulcers Common in late middle age incidence increases with age Male to female ratio—2:1 More common in patients with blood group A Use of NSAIDs - associated with a three- to four-fold increase in risk of gastric ulcer Less related to H. pylori than duodenal ulcers – about 80% 10 - 20% of patients with a gastric ulcer have a concomitant duodenal ulcer Malignancy Etiology A peptic ulcer is a mucosal break, 3 mm or greater, that can involve the stomach or duodenum. The most important contributing factors are H pylori, NSAIDs, acid, and pepsin. Additional aggressive factors include smoking, ethanol, bile acids, aspirin, steroids, and stress. Important protective factors are mucus, bicarbonate, mucosal blood flow, prostaglandins, hydrophobic layer, and epithelial renewal. Increased risk when older than 50 d/t decrease protection When an imbalance occurs, PUD might develop. Helicobactor pylori H. pylori→ ? →ulceration Prevalence of H. pylori: 80% in developing area; 20-50% in developed area The rate of H. pylori infection is declining in developed country Transmission: oral → oral fecal → oral Helicobactor pylori It is possible that the different disease related to H. pylori infection can be attribute to differe