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1、PepticUlcerDisease(PUD)ZhongLiangHuaShanHospitalDefinitionAcircumscribedulcerationofthegastrointestinalmucosaoccurringinareasexposedtoacidandpepsinandmostoftencausedbyHelicobacterpyloriinfection.(Uphold&Graham,2003)Pepticulcers: GastricandDuodenalPUDDemographicsHigherprevalenceindevelopingcountri
2、esH.PyloriissometimesassociatedwithsocioeconomicstatusandpoorhygieneIntheUS:Lifetimeprevalenceis~10%.PUDaffects~4.5millionannually.Hospitalizationrateis~30ptsper100,000cases.Mortalityratehasdecreaseddramaticallyinthepast20yearsapproximately1deathper100,000casesComparingDuodenal AndGastricUlcersEp
3、idemiology(DU)Duodenalsitesare4xascommonasgastricsitesMostcommoninmiddleagepeak30-50yearsMaletofemaleratio—4:1Geneticlink:3xmorecommonin1stdegreerelativesMorecommoninpatientswithbloodgroupOAssociatedwithincreasedserumpepsinogenH.pyloriinfectioncommonupto95%SmokingistwiceascommonGastricUlcersCommo
4、ninlatemiddleageincidenceincreaseswithageMaletofemaleratio—2:1MorecommoninpatientswithbloodgroupAUseofNSAIDs-associatedwithathree-tofour-foldincreaseinriskofgastriculcerLessrelatedtoH.pylorithanduodenalulcers–about80%10-20%ofpatientswithagastriculcerhaveaconcomitantduodenalulcerEtiologyApepticulc
5、erisamucosalbreak,3mmorgreater,thatcaninvolvethestomachorduodenum.ThemostimportantcontributingfactorsareHpylori,NSAIDs,acid,andpepsin.Additionalaggressivefactorsincludesmoking,ethanol,bileacids,aspirin,steroids,andstress.Importantprotectivefactorsaremucus,bicarbonate,mucosalbloodflow,prostaglandi
6、ns,hydrophobiclayer,andepithelialrenewal.Increasedriskwhenolderthan50d/tdecreaseprotectionWhenanimbalanceoccurs,PUDmightdevelop.HelicobactorpyloriH.pylori→?→ulcerationPrevalenceofH.pylori:80%indevelopingarea;20-50%indevelopedareaTherateofH.pyloriinfectionisdecliningindevelopedcountryTransmission:
7、oral→oralfecal→oralHelicobactorpyloriItispossiblethatthedifferentdiseaserelatedtoH.pyloriinfectioncanbeattributetodifferentstrainsoforganismwithdistinctpathogenicfeaturesHelicobactorpyloriHelicobactorpyloriNSAIDNSAID→C
