Peptic ulcer disease refers to ulcerative disorders in the lower esophagus, upper duodenum, and lower portion of the stomach. Approxiamtely 4 to 5 million people in the United States
710 Peptic Ulcer Disease have peptic ulcers, which are sharply circumscribed breaks of the mucosa that may extend through the tissue layers of the muscle and serosa into the abdominal cavity. The types of peptic ulcers are gastric and duodenal, both of which are chronic diseases. Stress ulcers, which are caused by a physiological response to major trauma, are clinically distinct from chronic peptic ulcers.
Gastric ulcers are less common than duodenal ulcers and usually occur in the lesser curvature of the stomach within 1 inch of the pylorus. The ulcer formation is caused by an inability of the mucosa to protect itself from damage by acid pepsin in the lumen (which is caused by a breakdown of the defensive factors). Duodenal ulcers occur in the proximal part of the duodenum (95%), are less than 1 cm in diameter, and are round or oval. A higher number of parietal cells in the stomach cause hypersecretion, or rapid emptying of the stomach; this may lead to a larger amount of acid being delivered to the first part of the duodenum and result in the formation of an ulcer. Hemorrhage and peritonitis can occur if the peptic ulcer erodes through the intestinal wall. Other complications include abdominal or intestinal infarction or erosion of the ulcer into the liver, pancreas, or biliary tract.
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