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1、PepticUlcerDisease(PUD)ZhongLiangHuaShanHospitalDefinitionAcircumscribedulcerationofthegastrointestinalmucosaoccurringinareasexposedtoacidandpepsinandmostoftencausedbyHelicobacterpyloriinfection.(Uphold&Graham,2003)Pepticulcers: GastricandDuodenalPUDDemographicsHigherprevalenceindevelopingcount
2、riesH.PyloriissometimesassociatedwithsocioeconomicstatusandpoorhygieneIntheUS:Lifetimeprevalenceis~10%.PUDaffects~4.5millionannually.Hospitalizationrateis~30ptsper100,000cases.Mortalityratehasdecreaseddramaticallyinthepast20yearsapproximately1deathper100,000casesComparingDuodenal AndGastricUlce
3、rsEpidemiology(DU)Duodenalsitesare4xascommonasgastricsitesMostcommoninmiddleagepeak30-50yearsMaletofemaleratio—4:1Geneticlink:3xmorecommonin1stdegreerelativesMorecommoninpatientswithbloodgroupOAssociatedwithincreasedserumpepsinogenH.pyloriinfectioncommonupto95%SmokingistwiceascommonGastricUlcer
4、sCommoninlatemiddleageincidenceincreaseswithageMaletofemaleratio—2:1MorecommoninpatientswithbloodgroupAUseofNSAIDs-associatedwithathree-tofour-foldincreaseinriskofgastriculcerLessrelatedtoH.pylorithanduodenalulcers–about80%10-20%ofpatientswithagastriculcerhaveaconcomitantduodenalulcerEtiologyAp
5、epticulcerisamucosalbreak,3mmorgreater,thatcaninvolvethestomachorduodenum.ThemostimportantcontributingfactorsareHpylori,NSAIDs,acid,andpepsin.Additionalaggressivefactorsincludesmoking,ethanol,bileacids,aspirin,steroids,andstress.Importantprotectivefactorsaremucus,bicarbonate,mucosalbloodflow,pr
6、ostaglandins,hydrophobiclayer,andepithelialrenewal.Increasedriskwhenolderthan50d/tdecreaseprotectionWhenanimbalanceoccurs,PUDmightdevelop.HelicobactorpyloriH.pylori→?→ulcerationPrevalenceofH.pylori:80%indevelopingarea;20-50%indevelopedareaTherateofH.pyloriinfectionisdecliningindevelopedcountryT
7、ransmission:oral→oralfecal→oralHelicobactorpyloriItispossiblethatthedifferentdiseaserelatedtoH.pyloriinfectioncanbeattributetodifferentstrainsoforganismwithdistinctpathogenicfeaturesHelicobactorpyloriHelicobactorpyloriNSAIDNSAID→C
