Review article
Peptic Ulcer Disease
Miroslava Katičić
Abstract
Peptic ulcer disease is characterised by
mucous damage in the upper gastrointestinal tract with tendency
to developed defects – ulcers in the gastrointestinal
mucosa that extend through the muscularis mucosae, caused
by autodigestion of the same mucosa as a function of the acid
or peptic activity in gastric juice. Peptic ulcers can develop
thought all parts of gastrointestinal tract with gastric juice activity,
fi rst of all in oesophagus, stomach and duodenum. Some
times they can occur in the proximal jejunum, and in ileum in
Meckel’s diverticula’s. The natural history of peptic ulcer ranges
from resolution without intervention to the development of complications
with the potential for signifi cant morbidity and mortality,
such as bleeding and perforation. Peptic ulcer disease is
associated with three major etiologic factors: Helicobacter pylori
infection, the consumption of nonsteroidal antiinfl ammatory
drugs (NSAIDs), and chronic stress. There are also a number of
other defi ned mechanisms for peptic ulcer that are much less
common but becoming more evident as the prevalence of H.
pylori declines in developed countries. Estimates of the annual
incidence of peptic ulcer range from 0.1 to 0.3 percent in noninfected
population. The ulcer incidence in H. pylori-infected
individuals is about 1 percent per year, a rate that is 6 to 10-fold
higher than for uninfected subjects. The lifetime prevalence is
also higher in H. pylori-positive subjects (approximately 10 to 20
percent compared to 5 to 10 percent in the general population).
The fi rst steps in ulcer management are to identify H. pylori
infection and users of NSAIDs. Treatment of peptic ulcer begins
with the eradication of H. pylori in all infected individuals. Antisecretory
therapy is the mainstay of therapy in uninfected patients,
and is appropriate for maintenance therapy in selected cases.
If is possible, it is essential to withdraw potential offending or
contributing agents such as NSAIDs, and salicilates. No fi rm
dietary recommendations are necessary; patients should avoid
foods that precipitate dyspepsia. Over the last two decades, the
development of potent antisecretory agents (H2 blockers and
proton pump inhibitors) and the recognition that treatment for
H. pylori infection can eliminate most ulcer recurrences. Peptic
ulcer disease nowadays only infrequently requires operation.
Surgery is still required as the emergency therapy of life-threatening
complications of aggressive and advanced disease, not
treatable by others conservative methods.
Keywords
peptic ulcer; symptoms; aetiology; pathogenesis; diagnostics; therapy; Helicobacter pylori; nonsteroidal antiinfl ammatory drugs
Hrčak ID:
18843
URI
Publication date:
26.1.2006.
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