Peptic ulcer

A peptic ulcer, also known as PUD or peptic ulcer disease,^[1] is











an ulcer (defined as mucosal erosions equal to or greater than 0.5 cm) of an area of the gastrointestinal tract that is usually acidic and thus extremely painful. As many as 70-90% of ulcers are associated with Helicobacter pylori, a spiral-shaped bacterium that lives in the acidic environment of the stomach; however, only 40% of those cases go to a doctor. Ulcers can also be caused or worsened by drugs such as aspirin, Plavix (clopidogrel), ibuprofen, and other NSAIDs.
Contrary to general belief, more peptic ulcers arise in the duodenum (first part of the small intestine, just after the stomach) rather than in the stomach. About 4% of stomach ulcers are caused by a malignant tumor, so multiple biopsies are needed to exclude cancer. Duodenal ulcers are generally benign.

Classification

By Region/Location

• Stomach (called gastric ulcer)
• Duodenum (called duodenal ulcer)
• Esophagus (called Esophageal ulcer)
• Meckel's Diverticulum (called Meckel's Diverticulum ulcer; is very tender with palpation)

Modified Johnson Classification of peptic ulcers:

• Type I: Ulcer along the body of the stomach, most often along the lesser curve at incisura angularis along the locus minoris resistentiae.
• Type II: Ulcer in the body in combination with duodenal ulcers. Associated with acid oversecretion.
• Type III: In the pyloric channel within 3 cm of pylorus. Associated with acid oversecretion.
• Type IV: Proximal gastroesophageal ulcer
• Type V: Can occur throughout the stomach. Associated with chronic NSAID use (such as aspirin).