PEPTIC ULCER DISEASE

• Acid peptic digestion of the alimentary mucosa resulting in an ulcer is called peptic ulcer disease (PUD).
• Duodenum and stomach are the common sites of peptic ulcer disease.
• Types of peptic ulcer

I. Depending on the site

1. Chronic duodenal ulcer: Typically occurs in the first inch of the first part of the duodenum.
2. Chronic gastric ulcer: Occurs in the lesser curvature adjacent to acid secreting parietal cell mass.
3. Combined: Gastric ulcer type II

Zollinger-Ellison syndrome

Anastomotic ulcer

ll. Depending on the duration

1. Chronic peptic ulcer
2. Acute peptic ulcer

Chronic duodenal ulcer (CDU)

• Hyperacidity is the chief cause of duodenal ulcer.
• Most common site is 1^st part of duodenum
• Most common in males.

Etiology-

• Stress and anxiety
• H.pylori (90%)
• NSAIDs, steroids
• Blood group O+ve
• Endocrine- Zollinger- Ellison syndrome, MEN- I, Cushing’s syndrome

 Pathophysiology-

• H. Pylori and NSAIDs induces injury to duodenum.

Clinical features-

• Epigastric pain
• Hunger pain
• Pain common at night
• Melena
• Weight gain  

Investigations-

Barium meal X-ray features-

• Deformed or absent duodenal cap
• Appearance of trifoliate defect in  duodenum
• Oesophagogastroduodenoscopy (duoduenal biopsy)  

Complications-

• Bleeding
• Most common site of bleeding from peptic ulcer- first part of duodenum
• Perforation
• Gastric outlet obstruction

 Treatment-

• H₂ receptors blocker (Ranitidine)- 8 weeks
• Proton pump inhibitors (pantaprazole is the first line of treatment for CDU).
• Diet control
• Surgery-

Highly selective vagotomy- procedure is of choice

Gastrectomy

1. Vagotomy and Antrectomy – lowest recurrence & highest morbidity
2. Gastroenterostomy alone – highest recurrence
3. Billroth II gastrectomy
4. Duodenal ulcer surgery
5. Truncal vagotomy & drainage
6. Truncal vagotomy & antrectomy

    Exam Important