Peptic ulcer natural history

Peptic ulcer Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Peptic Ulcer from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Study of Choice
History and Symptoms
Physical Examination
Laboratory Findings
Upper GI Endoscopy
X Ray
CT
MRI
Ultrasound
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery Endoscopic management Surgical management
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
2017 ACG Guidelines for Peptic Ulcer Disease
Guidelines for the Indications to Test for, and to Treat, H. pylori Infection
Guidelines for First line Treatment Strategies of Peptic Ulcer Disease for Providers in North America
Guidlines for factors that predict the successful eradication when treating H. pylori infection
Guidelines to document H. pylori antimicrobial resistance in the North America
Guidelines for evaluation and testing of H. pylori antibiotic resistance
Guidelines for when to test for treatment success after H. pylori eradication therapy
Guidelines for penicillin allergy in patients with H. pylori infection
Guidelines for the salvage therapy
Peptic ulcer natural history On the Web
Most recent articles
cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Peptic ulcer natural history All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Peptic ulcer natural history
CDC on Peptic ulcer natural history
Peptic ulcer natural history in the news
Blogs on Peptic ulcer natural history
to Hospitals Treating Peptic ulcer
Risk calculators and risk factors for Peptic ulcer natural history

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
• The duodenal ulcer occurs in second to fifth decade of life. where as gastric ulcer occurs in the 4th decade of life.
• Peptic ulcer disease starts 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.

Complications

Acute complications :

• Bleeding is the commonest complication.
  • Sudden large bleeding can be life threatening.
  • Bleeding occurs when the ulcer erodes one of the blood vessels around the stomach..
• Perforation
  • Perforation is most common occur at the duodenal bulb (62%), followed by the pyloric region (20%), and the gastric body (18%)
  • Erosion of the gastro-intestinal wall by the ulcer leads to spillage of stomach or intestinal content into abdominal cavity leading to catastrophic consequences.
  • 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 also a form of perforation, when the ulcer continues into adjacent organs such as liver and pancreas.
• Obstruction
  • Occurs as a result of stricture and scarring narrowing in the duodenum leading to gastric outlet obstruction.

Chronic complications:

Chronic Helicobacter pylori infection leads to

• Gastric cancer

• MALT cell lymphoma
• Iron deficiency anemia
• Idiopathic thrombocytopenic purpura

Prognosis

• Prognosis is generally good if the underlying cause is treated
• The recurrence rate of patients with peptic ulcer disease is approximately 20%.
• Depending on the extent of these [tumor/disease progression/etc.] at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as poor/good/excellent.
• The presence of [characteristic of disease] is associated with a particularly [good/poor] prognosis among patients with [disease/malignancy].
• [Subtype of disease/malignancy] is associated with the most favorable prognosis.
• The prognosis varies with the [characteristic] of tumor; [subtype of disease/malignancy] have the most favorable prognosis.

References

Template:WikiDoc Sources