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{{Peptic ulcer}}
{{Peptic ulcer}}
{{CMG}}; {{AE}} ;{{MKK}}
{{CMG}} ; {{AE}} {{MKK}}
==Overview==
==Overview==
Peptic ulcer disease may be classified into two categories 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 duodenal bulb.
[[Peptic ulcer]] disease may be classified into two types based on the location within the gastrointestinal tract. [[gastric]] [[ulcer]] and [[duodenal]] [[ulcer]]. [[Gastric]] [[ulcers]] are present mostly at lesser curvature of the [[stomach]] while [[Duodenal]] [[ulcers]] are mostly present at the duodenal bulb.
 
==Classification==
==Classification==
===Peptic ulcer===
===Peptic ulcer===
*Peptic ulcer disease may be classified according to location into two subtypes <ref name="pmid2750129">{{cite journal| author=Belousov AS, Rakitskaia LG, Mamedova LD, Zhakov VP| title=[Pathogenesis and classification of peptic ulcer]. | journal=Vrach Delo | year= 1989 | volume=  | issue= 3 | pages= 70-3 | pmid=2750129 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2750129  }} </ref><ref name="pmid22095009">{{cite journal| author=Tytgat GN| title=Etiopathogenetic principles and peptic ulcer disease classification. | journal=Dig Dis | year= 2011 | volume= 29 | issue= 5 | pages= 454-8 | pmid=22095009 | doi=10.1159/000331520 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22095009  }} </ref>
[[Peptic ulcer]] disease may be classified according to location into two subtypes: <ref name="pmid2750129">{{cite journal| author=Belousov AS, Rakitskaia LG, Mamedova LD, Zhakov VP| title=[Pathogenesis and classification of peptic ulcer]. | journal=Vrach Delo | year= 1989 | volume=  | issue= 3 | pages= 70-3 | pmid=2750129 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2750129  }} </ref><ref name="pmid22095009">{{cite journal| author=Tytgat GN| title=Etiopathogenetic principles and peptic ulcer disease classification. | journal=Dig Dis | year= 2011 | volume= 29 | issue= 5 | pages= 454-8 | pmid=22095009 | doi=10.1159/000331520 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22095009  }} </ref>
**Gastric ulcer
*Gastric [[ulcers]]
**Duodenal ulcer
*Duodenal [[Ulcer|ulcers]]
===Gastric ulcer===
 
====Based upon the location of ulcer====
=== Classification and prevalences of stigmata of recent hemorrhage of peptic ulcer using endoscopy ===
*Gastric ulcer is further classified into 3 subtypes depending upon their location by the Johnson<ref name="pmid5845595">{{cite journal |vauthors=Johnson HD |title=Gastric ulcer: classification, blood group characteristics, secretion patterns and pathogenesis |journal=Ann. Surg. |volume=162 |issue=6 |pages=996–1004 |year=1965 |pmid=5845595 |pmc=1477018 |doi= |url=}}</ref>
**Type 1:Ulcer present at the body of stomach without involving duodenum ,pyrolus or prepyrolic region
**Type 2:Ulcer present at the body of stomach combined with and probably seconadary to an ulcer or its scar in th duodenum or at pyrolus
**Type 3:Ulcer close to pyrolus 
====Based upon endoscopic findings====
{| class="wikitable"
{| class="wikitable"
! colspan="2" |'''Gastric ulcer classification by using endoscopic staging system of Sakita''' '''into three stages :Active ,Healing and Scarring:'''<ref name="pmid11085491">{{cite journal| author=Kaneko E, Hoshihara Y, Sakaki N, Harasawa S, Ashida K, Asaka M et al.| title=Peptic ulcer recurrence during maintenance therapy with H2-receptor antagonist following first-line therapy with proton pump inhibitor. | journal=J Gastroenterol | year= 2000 | volume= 35 | issue= 11 | pages= 824-31 | pmid=11085491 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11085491 }}</ref>
! colspan="3" |Classification and prevalences of  stigmata of recent hemorrhage of peptic ulcer using endoscopy*
|-
! colspan="2" |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 seenn
|-
| colspan="2" style="padding: 5px 5px; background: #F5F5F5;" align="center" |                                                                                                                                                                                                                                                        '''HEALING STAGE'''
|-
|-
|H1
|Stigmata of [[hemorrhage]]
|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
|-
| colspan="2" style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''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’’
|}
{| class="wikitable"
! colspan="3" |Classification and prevalences of stigmata of recent hemorrhage using endoscopy
|-
|Stigmata of hemorrhage
|Forrest classification
|Forrest classification
|Prevalence
|Prevalence
|-
|-
|Active spurting bleeding
|Active spurting [[bleeding]]
|IA
|IA
|12%(spurting+oozing)
|12%(spurting+oozing)
|-
|-
|Active oozing bleeding
|Active oozing [[bleeding]]
|IB
|IB
|
|
|-
|-
|Non-bleeding visible vessel
|Non-[[bleeding]] visible [[vessel]]
|IIA
|IIA
|8%
|8%
|-
|-
|Adherent clot
|Adherent [[clot]]
|IIB
|IIB
|8%
|8%
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|}
|}
<small>*Adopted:American college of gasteroenterology<ref name="urlManagement of Patients with Ulcer Bleeding | American College of Gastroenterology">{{cite web |url=https://gi.org/guideline/management-of-patients-with-ulcer-bleeding/ |title=Management of Patients with Ulcer Bleeding &#124; American College of Gastroenterology |format= |work= |accessdate=}}</ref> </small>
<small>*Adopted:American college of gasteroenterology<ref name="urlManagement of Patients with Ulcer Bleeding | American College of Gastroenterology">{{cite web |url=https://gi.org/guideline/management-of-patients-with-ulcer-bleeding/ |title=Management of Patients with Ulcer Bleeding &#124; American College of Gastroenterology |format= |work= |accessdate=}}</ref> </small>
==Gastric ulcer==
[[Gastric]] [[ulcer]] is further divided on the basis of location and endoscopic findings:
====Johnson classification====
*[[Gastric]] [[ulcer]] is further classified into 3 subtypes depending upon their location:<ref name="pmid5845595">{{cite journal |vauthors=Johnson HD |title=Gastric ulcer: classification, blood group characteristics, secretion patterns and pathogenesis |journal=Ann. Surg. |volume=162 |issue=6 |pages=996–1004 |year=1965 |pmid=5845595 |pmc=1477018 |doi= |url=}}</ref><ref name="pmid14058266">{{cite journal |vauthors=BARON JH |title=AN ASSESSMENT OF THE AUGMENTED HISTAMINE TEST IN THE DIAGNOSIS OF PEPTIC ULCER. CORRELATIONS BETWEEN GASTRIC SECRETION, AGE AND SEX OF PATIENTS, AND SITE AND NATURE OF THE ULCER |journal=Gut |volume=4 |issue= |pages=243–53 |year=1963 |pmid=14058266 |pmc=1413442 |doi= |url=}}</ref><ref name="pmid13234346">{{cite journal |vauthors=JOHNSON HD |title=The special significance of concomitant gastric and duodenal ulcers |journal=Lancet |volume=268 |issue=6858 |pages=266–70 |year=1955 |pmid=13234346 |doi= |url=}}</ref>
**Type 1: [[Ulcer]] present at the body of [[stomach]] without involving [[duodenum]], [[pylorus]] or prepyloric region and not associated with hypersecretion of gastric acid
**Type 2: [[Ulcer]] present at the body of [[stomach]] combined with [[duodenum]] and associated with gastric acid hypersecretion 
**Type 3: [[:Ulcer]] close to [[pylorus]] and associated with gastric acid hypersecretion
====Sakita classification====
* Gastric ulcer classification by using endoscopic staging system of Sakita into three stages:<ref name="pmid11085491">{{cite journal| author=Kaneko E, Hoshihara Y, Sakaki N, Harasawa S, Ashida K, Asaka M et al.| title=Peptic ulcer recurrence during maintenance therapy with H2-receptor antagonist following first-line therapy with proton pump inhibitor. | journal=J Gastroenterol | year= 2000 | volume= 35 | issue= 11 | pages= 824-31 | pmid=11085491 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11085491  }}</ref>
** Active
** Healing
** Scarring
{| class="wikitable"
|-
! colspan="2" |ACTIVE STAGE
|-
|A1
|Surrounding mucosa is found to be edematously swollen and there is no regenerating epithelium seen on [[endoscopy]]
|-
|A2
|Surrounding mucosa is less edematous, a small amount of regenerating [[epithelium]] is seen at  the [[ulcer]] margin
A red halo in the marginal zone, a white slough circle and converging mucosal folds  t the [[ulcer]] margin are frequently seen
|-
| colspan="2" style="padding: 5px 5px; background: #F5F5F5;" align="center" |                                                                                                                                                                                                                                                        '''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
|-
| colspan="2" style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''SCARRING STAGE'''
|-
|S1
|The regenerating epithelium completely covers the floor of the [[Ulcer|ulcer]]
The white coating has disappeared
Initially, the regenerating region is markedly red but upon close observation, many capillaries can be seen and this is called ‘‘red scar’’
|-
|S2
|In several months to a few years, the redness is reduced to the color of the surrounding mucosa and this is called ‘‘white scar’’
|}


==References==
==References==
{{reflist|2}}
{{reflist|2}}
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Latest revision as of 23:37, 29 July 2020

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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 within the gastrointestinal tract. gastric ulcer and duodenal ulcer. Gastric ulcers are present mostly at lesser curvature of the stomach while Duodenal ulcers are mostly present at the duodenal bulb.

Classification

Peptic ulcer

Peptic ulcer disease may be classified according to location into two subtypes: [1][2]

Classification and prevalences of stigmata of recent hemorrhage of peptic ulcer using endoscopy

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[3]

Gastric ulcer

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

Johnson classification

  • Gastric ulcer is further classified into 3 subtypes depending upon their location:[4][5][6]
    • Type 1: Ulcer present at the body of stomach without involving duodenum, pylorus or prepyloric region and not associated with hypersecretion of gastric acid
    • Type 2: Ulcer present at the body of stomach combined with duodenum and associated with gastric acid hypersecretion
    • Type 3: Ulcer close to pylorus and associated with gastric acid hypersecretion

Sakita classification

  • Gastric ulcer classification by using endoscopic staging system of Sakita into three stages:[7]
    • Active
    • Healing
    • Scarring
ACTIVE STAGE
A1 Surrounding mucosa is found to be edematously swollen and there is no regenerating epithelium seen on endoscopy
A2 Surrounding mucosa is less edematous, a small amount of regenerating epithelium is seen at the ulcer margin

A red halo in the marginal zone, a white slough circle and converging mucosal folds t 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 the ulcer

The white coating has disappeared

Initially, the regenerating region is markedly red but upon close observation, many capillaries can be seen and this is called ‘‘red scar’’

S2 In several months to a few years, the redness is reduced to the color of the surrounding mucosa and this is called ‘‘white scar’’

References

  1. Belousov AS, Rakitskaia LG, Mamedova LD, Zhakov VP (1989). "[Pathogenesis and classification of peptic ulcer]". Vrach Delo (3): 70–3. PMID 2750129.
  2. Tytgat GN (2011). "Etiopathogenetic principles and peptic ulcer disease classification". Dig Dis. 29 (5): 454–8. doi:10.1159/000331520. PMID 22095009.
  3. "Management of Patients with Ulcer Bleeding | American College of Gastroenterology".
  4. Johnson HD (1965). "Gastric ulcer: classification, blood group characteristics, secretion patterns and pathogenesis". Ann. Surg. 162 (6): 996–1004. PMC 1477018. PMID 5845595.
  5. BARON JH (1963). "AN ASSESSMENT OF THE AUGMENTED HISTAMINE TEST IN THE DIAGNOSIS OF PEPTIC ULCER. CORRELATIONS BETWEEN GASTRIC SECRETION, AGE AND SEX OF PATIENTS, AND SITE AND NATURE OF THE ULCER". Gut. 4: 243–53. PMC 1413442. PMID 14058266.
  6. JOHNSON HD (1955). "The special significance of concomitant gastric and duodenal ulcers". Lancet. 268 (6858): 266–70. PMID 13234346.
  7. Kaneko E, Hoshihara Y, Sakaki N, Harasawa S, Ashida K, Asaka M; et al. (2000). "Peptic ulcer recurrence during maintenance therapy with H2-receptor antagonist following first-line therapy with proton pump inhibitor". J Gastroenterol. 35 (11): 824–31. PMID 11085491.

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