Peptic ulcer disease
1. Peptic Ulcer DiseaseGastric Ulcer
2. Ulcerogenic Factors
1. Hyper secretion of HCl and pepsin
2. H. pylori
3. Chronic gastritis “B” and metaplasia into
4. Failure of gastroduodenal movement
5. Genetic susceptibility
4. Pathophysiology of peptic ulcer diseaseAbnormalities in the secretion of gastric acid
and pepsin,and on the suppression of acid as a
Gastric hypersecretion-associated with
gastrinoma in Zollinger-Ellision syndrome,antral
G-cell hyperplasia,an increase in parietal-cell
mass and physiological imbalance between the
antagonistic gastric hormones gastrin and
somatostatin-is still an important issue in peptic
5. Management and Prevention of NSAID-associated peptic ulcerMisoprostol, a mucosal-protective
analogue of prostaglandin E2 reduces
the risk if ulcer complications,but only at
the recommended dose of 800 ug/day.
Lower doses of misoprostol are not
Perforation of ulcer.
Decompensating pyloroduodenal stenosis.
Profuse GIT bleeding.
2. Indirect indications:
Penetration into contiguous organs.
Long –term medical history with recurrences of ulcer
Unsuccessful drugs therapy .
Indirect indications are changeable according trials.
duodenal ulcer surgery are:
Perforation of ulcer;
Profuse GIT bleeding after
Penetration into contiguous organs;
Long –term medical history with
recurrences of ulcer with
unsuccessful drug therapy.
1) Complicated ulcer (perforation, bleeding,
2) no effect drug therapy fro three months;
3) Long –term medical history with recurrences of
ulcer with unsuccessful drug therapy;
4) Chronic ulcer with epithelial dysplasia IIIst or
subcardial [juxtacardial, type IV gastric] ulcer.
9. Johnston` s classification of gastric ulcer (1965):I type — ulcer of lesser curvature of stomach ( 3 sм
II type — combined ulcer`s of duodenum and
III type — ulcer`s of pylorus ( up to 3 sм).
IV type - subcardial ( juxtacardial ) ulcer
2 sм from esophagus sphincter)
V type — drug related ulcers