内科精品教学（重庆医科大学）3、2011peptic ulcer wurong.pptVIP

Peptic Ulcer 　 Department of Gastroenterology and Hepatology The Second Affiliated Hospital Chongqing Medical University Introduction Definition: PU is ulceration which may occur at any site in the gastrointestinal tract that is exposed to acid-pepsin secretion. (“no acid, no ulcer.”) Defects in the gastrointestinal mucosa extending through the muscularis mucosae into the submucosa or muscularis Definition Ulcer : defects in the gastrointestinal mucosa penetrate the muscularis mucosa Erosion : small superficial mucosal lesions do not penetrate the muscularis mucosa ulcer erosion Introduction Typical ulcers: Gastric ulcer (GU) , Duodenal ulcer (DU) Introduction Two major causes: Hp (helicobacter pylori) NSAIDs (non-steroidal anti-inflammatory drugs) Aicd hypersecretory states such as Zollinger-Ellison syndrome Main mechanism: Imbalance between aggressive factors and mucosal defenses aggressive ~ defensive,repairing ~ Hp medicine(NSAIDS) gastric acid and pepsin other factors: stress,smoking,coffee, alcohol mucus(excluding pepsin) bicarbonate(neutralizing acid) mucosal barrier mucosal blood flow prostaglandins epithelial cell restitution epithelial cell replication  Balance Hypothesis  gastric ulcer ---------- defensive factors weakenduodenum ulcer ----- aggressive factors strengthen Epidemiology Peptic ulcers (PU) occur in up to 10~15% of the population at some time, and are more common in men. In DU and GU, men : women=4.4~6.8:1 and 3.6~4.7:1 respectively. Duodenal ulcers (DU) are more common than gastric ulcers (GU). PU occur at different age. DU are about 10 times more common than GU in young patients, but in the older age groups the frequency is about equal. Etiology and Pathophysiology 1. Normal mucosal defense and healing Regulation of acid-pepsin secretion: balance between neural, endocrine, paracrine, and