Chronic gastroduodenal ulcer

1- Definition and comparison between UD and UG:

• gastric or duodenal substance loss of non-tumor origin

• Chronic Disease (MUGD) evolving by recurrent acute attacks

– Duodenal ulcer (DU)

– Gastric ulcer (UG)

• Elderly often asymptomatic ulcers revealed by a complication (bleeding or perforation). Promoting the role of NSAIDs in the over 65 year old patient.

Chronic gastroduodenal ulcer2- Etiology:

• imbalance between aggressive factors (gastric acid, pepsin, bile acids, pancreatic enzymes) and protective factors of gastric mucosa (mucus, bicarbonate, blood flow, prostaglandins, growth factors, cell renewal)

• Helicobacter pylori is found in 90% of drug users (70% for UG). It is a major factor in the ulcérogenèse, in addition to gastric acid secretion.

• The Gastrotoxic treatments such as NSAIDs or aspirin can be responsible for ulcers, more often than gastric duodenal, or aggravate preexisting ulcers.

Risk factors:

• Demonstrated: acid hypersecretion (especially during Zollinger-Ellison syndrome), H. pylori infection (UD for UG), smoking, taking gastro-toxic drugs (NSAIDs, aspirin), family history of MUGD, pancreatitis Chronic (UD), cirrhosis

• Possible: corticosteroids (prolonged high doses), blood group O

• Very little or not probable: spices, alcohol, caffeine, paracetamol

3- Clinical signs:

• Pain

– Usually, epigastric cramps or burning occurring 1-3 hours after meals, relieved by food, antacids or anti-secretory, willingly waking the patient before morning. These pains gladly have a recurrent one.

– Sometimes vague pains, type of digestive discomfort, cramps, painful hunger

• Dyspepsia, heartburn

• Vomiting postprandial (unusual, should be investigated, pyloroduodenal stenosis)

• Signs of complications (greater frequency of asymptomatic forms revealed by a complication in patients taking an NSAID)

– Perforation (severe abdominal pain quickly diffuse)

– Bleeding (haematemesis, melena, more rarely iron deficiency anemia)

4- Diagnostic tests:

Laboratory tests:

• Iron deficiency anemia (first eliminate colic because before assigning the ulcer)

• Identification of H. pylori infection (culture of biopsies, fast urea test, serology)

• Study of gastric secretion and assay of gastrin (only looking for a ZE)

Esophageal-gastroduodenal endoscopy, the ulcer can locate and biopsies


• Loss of mucous substance reaching the muscular

• Diameter frequently ulcer> 5 mm

• H. pylori present (antral biopsies) in 90% of drug users, and over 75% of UG

5- Diagnosis:

+ Diagnosis:

• Endoscopy (sensitivity> 95%)

• Biopsies perendoscopic

– In the den in search of H. pylori

– On the banks of the ulcer in case of UG (++, differential diagnosis of ulcerative cancer)

Differential diagnosis:

• Cancer shape if ulcerated UG. The repeat endoscopy and biopsies after medical treatment is imperative.

• Gastroesophageal reflux disease

• Non-ulcer Dyspepsia

• Acute Gastritis (drug, allergy, infectious …)

• Cholelithiasis

• Pancreatitis

• Angina => posterolateral diaphragmatic infarction: vagal signs.

• Achievement of gastric Crohn’s disease