Peptic ulcer natural history
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2017 ACG Guidelines for Peptic Ulcer Disease |
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Guidelines for the Indications to Test for, and to Treat, H. pylori Infection |
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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 ulcers tend to come back if untreated. Cure rates are high and recurrence is low, if patient is compliant to treatment.
Natural History
- The infection of Helicobacter pylori ,common cause of peptic ulcer disease is acquired usually during the childhood , mainly in those who have low socioeconomic status, increased number of siblings and similar infection in the mother[1][2][3] Peptic ulcer disease classified into duodenal ulcer and gastric ulcer .The duodenal ulcer occurs in second to fifth decade of life.The gastric ulcer occurs in the 4th decade of life.It start with symptoms such as episodic epigastric pain, indigestion,bloating.Without treatment, the patient will develop symptoms of perforation like severe abdominal pain.Chronic infection leads to gastric atrophy ,gastric metaplasia and ultimately leads to gastric cancer and MALT lymphoma [4]
Complications
Acute and common complications :
- Bleeding:s the commonest complication. Sudden large bleeding can be life threatening[5]. It occurs when the ulcer erodes one of the blood vessels.
- Perforation :(a hole in the wall) often leads to catastrophic consequences. Erosion of the gastro-intestinal wall by the ulcer leads to spillage of stomach or intestinal content into abdominal cavity. Perforation at the anterior surface of stomach leads to acute peritonitis, initially chemical and later bacterial peritonitis. Often first sign is sudden intense abdominal pain. Posterior wall perforation leads to pancreatitis; pain in this situation often radiates to back.
- Penetration is when the ulcer continues into adjacent organs such as liver and pancreas[6].
- Peritonitis
- Obstruction
- Stricture
- Gastrointestinal bleeding is the commonest complication. Sudden large bleeding can be life threatening[5]. It occurs when the ulcer erodes one of the blood vessels.
- Perforation (a hole in the wall) often leads to catastrophic consequences. Erosion of the gastro-intestinal wall by the ulcer leads to spillage of stomach or intestinal content into abdominal cavity. Perforation at the anterior surface of stomach leads to acute peritonitis, initially chemical and later bacterial peritonitis. Often first sign is sudden intense abdominal pain. Posterior wall perforation leads to pancreatitis; pain in this situation often radiates to back.
- Penetration is when the ulcer continues into adjacent organs such as liver and pancreas[7].
- Scarring and swelling due to ulcers causes narrowing in the duodenum and gastric outlet obstruction. Patient often presents with severe vomiting.
Chronic and rare complications:
- Gastric cancer-Chronic Helicobacter pylori leads to
- MALT cell lymphoma
- Iron deficiency anemia
- Idiopathic thrombocytopenic purpuras
- Signs of bleeding:
- Melena -blood in stools
- Hematemesis-blood in vomitus
- Anemia-pale colored skin, shortness of breath during physical activity, tachycardia
Prognosis
References
- ↑ Opekun AR, Gilger MA, Denyes SM, Nirken MH, Philip SP, Osato MS, Malaty HM, Hicks J, Graham DY (2000). "Helicobacter pylori infection in children of Texas". J. Pediatr. Gastroenterol. Nutr. 31 (4): 405–10. PMID 11045838.
- ↑ Parkinson AJ, Gold BD, Bulkow L, Wainwright RB, Swaminathan B, Khanna B, Petersen KM, Fitzgerald MA (2000). "High prevalence of Helicobacter pylori in the Alaska native population and association with low serum ferritin levels in young adults". Clin. Diagn. Lab. Immunol. 7 (6): 885–8. PMC 95979. PMID 11063492.
- ↑ Malaty HM, El-Kasabany A, Graham DY, Miller CC, Reddy SG, Srinivasan SR, Yamaoka Y, Berenson GS (2002). "Age at acquisition of Helicobacter pylori infection: a follow-up study from infancy to adulthood". Lancet. 359 (9310): 931–5. doi:10.1016/S0140-6736(02)08025-X. PMID 11918912.
- ↑ Kusters JG, van Vliet AH, Kuipers EJ (2006). "Pathogenesis of Helicobacter pylori infection". Clin. Microbiol. Rev. 19 (3): 449–90. doi:10.1128/CMR.00054-05. PMC 1539101. PMID 16847081.
- ↑ 5.0 5.1 Cullen DJ, Hawkey GM, Greenwood DC; et al. (1997). "Peptic ulcer bleeding in the elderly: relative roles of Helicobacter pylori and non-steroidal anti-inflammatory drugs". Gut. 41 (4): 459–62. PMID 9391242.
- ↑ "Peptic Ulcer: Peptic Disorders: Merck Manual Home Edition". Retrieved 2007-10-10.
- ↑ "Peptic Ulcer: Peptic Disorders: Merck Manual Home Edition". Retrieved 2007-10-10.
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Associate Editor(s)-in-Chief: Manpreet Kaur, MD [3]