内科学 消化性溃疡-钟良【荐】.ppt

Peptic Ulcer Disease (PUD) Zhong Liang Hua Shan Hospital Definition A circumscribed ulceration of the gastrointestinal mucosa occurring in areas exposed to acid and pepsin and most often caused by Helicobacter pylori infection. (Uphold Graham, 2003) Peptic ulcers:Gastric and Duodenal PUD Demographics Higher prevalence in developing countries H. Pylori is sometimes associated with socioeconomic status and poor hygiene In the US: Lifetime prevalence is ~10%. PUD affects ~4.5 million annually. Hospitalization rate is ~30 pts per 100,000 cases. Mortality rate has decreased dramatically in the past 20 years approximately 1 death per 100,000 cases Comparing Duodenal And Gastric Ulcers Epidemiology (DU) Duodenal sites are 4x as common as gastric sites Most common in middle age peak 30-50 years Male to female ratio—4:1 Genetic link: 3x more common in 1st degree relatives More common in patients with blood group O Associated with increased serum pepsinogen H. pylori infection common up to 95% Smoking is twice as common Gastric Ulcers Common in late middle age incidence increases with age Male to female ratio—2:1 More common in patients with blood group A Use of NSAIDs - associated with a three- to four-fold increase in risk of gastric ulcer Less related to H. pylori than duodenal ulcers – about 80% 10 - 20% of patients with a gastric ulcer have a concomitant duodenal ulcer Etiology A peptic ulcer is a mucosal break, 3 mm or greater, that can involve the stomach or duodenum. The most important contributing factors are H pylori, NSAIDs, acid, and pepsin. Additional aggressive factors include smoking, ethanol, bile acids, aspirin, steroids, and stress. Important protective factors are mucus, bicarbonate, mucosal blood flow, prostaglandins, hydrophobic layer, and epithelial renewal. Increased risk when older than 50 d/t decrease protection When an imbalance occurs, PUD might develop. Helicobactor pylori H. pylori→ ? →ulceration Prevalence of H. pylor