Peptic ulcer classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Manpreet Kaur, MD [2]

Overview

Peptic ulcer disease may be classified into two types based on the location, gastric ulcer and duodenal ulcer. Gastric ulcers are present mostly at lesser curvature of the stomach. Duodenal ulcers are mostly present at the duodenal bulb.

Classification

Peptic ulcer

• Peptic ulcer disease may be classified according to location into two subtypes
  • Gastric ulcers
  • Duodenal ulcers

Classification and prevalences of stigmata of recent hemorrhage of peptic ulcer using endoscopy*
Stigmata of hemorrhage	Forrest classification	Prevalence
Active spurting bleeding	IA	12%(spurting+oozing)
Active oozing bleeding	IB
Non-bleeding visible vessel	IIA	8%
Adherent clot	IIB	8%
Flat pigmented spot	IIC	16%
Clean base	III	55%

*Adopted:American college of gasteroenterology

Gastric ulcer

Gastric ulcer is further divided on the basis of location and endoscopic findings:

Based upon the location of ulcer

• Gastric ulcer is further classified into 3 subtypes depending upon their location by the Johnson
  • Type 1:Ulcer present at the body of stomach without involving duodenum ,pyrolus or prepyrolic region
  • Type 2Ulcer present at the body of stomach combined with and probably seconadary to an ulcer or its scar in th duodenum or at pyrolus
  • Type 3Ulcer close to pyrolus

Based upon endoscopic findings

Gastric ulcer classification by using endoscopic staging system of Sakita into three stages :Active ,Healing and Scarring:
ACTIVE STAGE
A1	Surrounding mucosa is found to be edematously swollen and there is no regeneration epithelium seen in endoscopy
A2	Surrounding edema has decreased, a small amount of regenerating epithelium is seen in the ulcer margin. A red halo in the marginal zone and a white slough circle and converging mucosal folds in the ulcer margin are frequently seen
HEALING STAGE
H1	The white coating is becoming thin and the regenerating epithelium is extending into the ulcer base. The gradient between the ulcer margin and the ulcer floor is becoming flat. The ulcer crater is still evident and the margin of the ulcer is sharp. The diameter of the mucosal defect is about one-half to two thirds that of A1
H2	The defect is smaller than in H1 and the regenerating epithelium covers most of the ulcer floor. The area of white coating is about a quarter to one-third that of A1
SCARRING STAGE
S1	The regenerating epithelium completely covers the floor of ulcer. The white coating has disappeared. Initially, the regenerating region is markedly red. Upon close observation, many capillaries can be seen. This is called ‘‘red scar’’
S2	In several months to a few years, the redness is reduced to the color of the surrounding mucosa. This is called ‘‘white scar’’

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