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1、PepticUlcerDisease(PUD)ZhongLiangHuaShanHospitalDefinitionAcircumscribedulcerationofthegastrointestinalmucosaoccurringinareasexposedtoacidandpepsinandmostoftencausedbyHelicobacterpyloriinfection.(Uphold&Graham,2003)Pepticulcers: GastricandDuodenalPUDDemographicsHig
2、herprevalenceindevelopingcountriesH.PyloriissometimesassociatedwithsocioeconomicstatusandpoorhygieneIntheUS:Lifetimeprevalenceis~10%.PUDaffects~4.5millionannually.Hospitalizationrateis~30ptsper100,000cases.Mortalityratehasdecreaseddramaticallyinthepast20yearsapprox
3、imately1deathper100,000casesComparingDuodenal AndGastricUlcersEpidemiology(DU)Duodenalsitesare4xascommonasgastricsitesMostcommoninmiddleagepeak30-50yearsMaletofemaleratio—4:1Geneticlink:3xmorecommonin1stdegreerelativesMorecommoninpatientswithbloodgroupOAssociatedwi
4、thincreasedserumpepsinogenH.pyloriinfectioncommonupto95%SmokingistwiceascommonGastricUlcersCommoninlatemiddleageincidenceincreaseswithageMaletofemaleratio—2:1MorecommoninpatientswithbloodgroupAUseofNSAIDs-associatedwithathree-tofour-foldincreaseinriskofgastriculcer
5、LessrelatedtoH.pylorithanduodenalulcers–about80%10-20%ofpatientswithagastriculcerhaveaconcomitantduodenalulcerEtiologyApepticulcerisamucosalbreak,3mmorgreater,thatcaninvolvethestomachorduodenum.ThemostimportantcontributingfactorsareHpylori,NSAIDs,acid,andpepsin.Add
6、itionalaggressivefactorsincludesmoking,ethanol,bileacids,aspirin,steroids,andstress.Importantprotectivefactorsaremucus,bicarbonate,mucosalbloodflow,prostaglandins,hydrophobiclayer,andepithelialrenewal.Increasedriskwhenolderthan50d/tdecreaseprotectionWhenanimbalance
7、occurs,PUDmightdevelop.HelicobactorpyloriH.pylori→?→ulcerationPrevalenceofH.pylori:80%indevelopingarea;20-50%indevelopedareaTherateofH.pyloriinfectionisdecliningindevelopedcountryTransmission:oral→oralfecal→oralHelicobactorpyloriItispossiblethatthedifferentdiseaser
8、elatedtoH.pyloriinfectioncanbeattributetodifferentstrainsoforganismwithdistinctpathogenicfeaturesHelicobactorpyloriHelicobactorpyloriNSAIDNSAID→C
