Chronic gastric ulcer

GI bleed is the commonest complication of acute or chronic gastric ulcer.

Outlet obstruction is the least commonest complication.

Majority of gastric ulcers (GUs) can be attributed to either H. pylori or NSAID-induced mucosal damage.

Gastric ulcers have been classified based on their location: 

• Type I occur in the gastric body and tend to be associated with low gastric acid production
• Type II occur in the antrum and gastric acid can vary from low to normal
• Type III occur within 3 cm of the pylorus and are commonly accompanied by duodenal ulcers and normal or high gastric acid production
• Type IV are found in the cardia and are associated with low gastric acid production.

Ans. is ‘d’ i.e., Massive haematemesis 

• Most common complication of peptic ulcer is gastro intestinal bleeding.
• It is seen with both chronic and acute type of ulcers. Infact, chronic peptic ulcers are the most common cause of haematemesis and malaena.

Complications of peptic ulcer ‑

1)    Gastrointestinal bleeding Most common complication of peptic ulcer

Bleeding is more common in duodenal ulcers

It is commonly seen in posterior duodenal ulcers because of erosion of gastroduodenal artery.

2)    Perforation

It is the second most common complication of peptic ulcer disease.

Perforation occurs commonly in the ulcers located in the anterior part of duodenum.

Duodenal ulcers tend to penetrate into pancreas causing pancreatitis.

Gastric ulcers tend to penetrate into left hepatic lobe.

3)   Gastric outlet obstruction It is the least common ulcer related complication.

It is commonly associated with duodenal ulcers.

Tea pot stomach is caused due to longitudinal shortening of the gastric ulcer at the lesser curvature of the stomach (It causes the stomach to look like tea pot).

Hour glass stomach is caused due to cicatricial contraction of a saddle shaped ulcer at the lesser curvature.

Answer is B (High Acid Output)

Gastric ulcers are associated with normal or decreased gastric acid output. High Acid output is a feature of Duodenal Ulcers.

`Gastric acid output (basal and stimulated) tend to be normal or decreased in Gastric Ulcer Patient’s’- Harrison

Aetiological factors in peptic ulceration:

The answer is D (Lesser Curvature near incisura angularis)

• The most common site of gastric ulcers is the lesser curvature near incisura.
• Approximately 60% of ulcers are in this location and are classified as type I gastric ulcers.
• These ulcers are generally not associated with excessive acid secretion and may occur with low to normal acid output.

Answer is D (Haemorrhage):

The most common complication of both acute and chronic peptic ulcers is gastrointestinal haemorrhage. `Haemorrhage is the commonest complication of chronic peptic ulcers ^‘–