Peptic ulcer classification: Difference between revisions

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*[[Gastric]] [[ulcer]] is further classified into 3 subtypes depending upon their location:<ref name="pmid5845595">{{cite journal |vauthors=Johnson HD |title=Gastric ulcer: classification, blood group characteristics, secretion patterns and pathogenesis |journal=Ann. Surg. |volume=162 |issue=6 |pages=996–1004 |year=1965 |pmid=5845595 |pmc=1477018 |doi= |url=}}</ref>
*[[Gastric]] [[ulcer]] is further classified into 3 subtypes depending upon their location:<ref name="pmid5845595">{{cite journal |vauthors=Johnson HD |title=Gastric ulcer: classification, blood group characteristics, secretion patterns and pathogenesis |journal=Ann. Surg. |volume=162 |issue=6 |pages=996–1004 |year=1965 |pmid=5845595 |pmc=1477018 |doi= |url=}}</ref>
**Type 1: [[Ulcer]] present at the body of [[stomach]] without involving [[duodenum]], [[pylorus]] or prepyloric region  
**Type 1: [[Ulcer]] present at the body of [[stomach]] without involving [[duodenum]], [[pylorus]] or prepyloric region  
**Type 2[[:Ulcer]] present at the body of [[stomach]] combined with [[duodenum]] or [[pylorus]]
**Type 2[[:Ulcer]] present at the body of [[stomach]] combined with [[duodenum]]   
**Type 3: [[:Ulcer]] close to [[pylorus]]   
**Type 3: [[:Ulcer]] close to [[pylorus]]   
====Sakita classification====
====Sakita classification====

Revision as of 17:17, 6 December 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Manpreet Kaur, MD [2]

Overview

Peptic ulcer disease may be classified into two types based on the location within the gastrointestinal tract. gastric ulcer and duodenal ulcer. Gastric ulcers are present mostly at lesser curvature of the stomach while Duodenal ulcers are mostly present at the duodenal bulb.

Classification

Peptic ulcer

Peptic ulcer disease may be classified according to location into two subtypes: [1][2]

Classification and prevalences of stigmata of recent hemorrhage of peptic ulcer using endoscopy

Classification and prevalences of stigmata of recent hemorrhage of peptic ulcer using endoscopy*
Stigmata of hemorrhage Forrest classification Prevalence
Active spurting bleeding IA 12%(spurting+oozing)
Active oozing bleeding IB
Non-bleeding visible vessel IIA 8%
Adherent clot IIB 8%
Flat pigmented spot IIC 16%
Clean base III 55%

*Adopted:American college of gasteroenterology[3]

Gastric ulcer

Gastric ulcer is further divided on the basis of location and endoscopic findings:

Johnson classification

Sakita classification

  • Gastric ulcer classification by using endoscopic staging system of Sakita into three stages:[5]
    • Active
    • Healing
    • Scarring
ACTIVE STAGE
A1 Surrounding mucosa is found to be edematously swollen and there is no regenerating epithelium seen on endoscopy
A2 Surrounding mucosa is less edematous, a small amount of regenerating epithelium is seen at the ulcer margin

A red halo in the marginal zone, a white slough circle and converging mucosal folds t the ulcer margin are frequently seen

HEALING STAGE
H1 The white coating is becoming thin and the regenerating epithelium is extending into the ulcer base

The gradient between the ulcer margin and the ulcer floor is becoming flat

The ulcer crater is still evident and the margin of the ulcer is sharp

The diameter of the mucosal defect is about one-half to two thirds that of A1

H2 The defect is smaller than in H1 and the regenerating epithelium covers most of the ulcer floor. The area of white coating is about a quarter to one-third that of A1
SCARRING STAGE
S1 The regenerating epithelium completely covers the floor of the ulcer

The white coating has disappeared

Initially, the regenerating region is markedly red but upon close observation, many capillaries can be seen and this is called ‘‘red scar’’

S2 In several months to a few years, the redness is reduced to the color of the surrounding mucosa and this is called ‘‘white scar’’

References

  1. Belousov AS, Rakitskaia LG, Mamedova LD, Zhakov VP (1989). "[Pathogenesis and classification of peptic ulcer]". Vrach Delo (3): 70–3. PMID 2750129.
  2. Tytgat GN (2011). "Etiopathogenetic principles and peptic ulcer disease classification". Dig Dis. 29 (5): 454–8. doi:10.1159/000331520. PMID 22095009.
  3. "Management of Patients with Ulcer Bleeding | American College of Gastroenterology".
  4. Johnson HD (1965). "Gastric ulcer: classification, blood group characteristics, secretion patterns and pathogenesis". Ann. Surg. 162 (6): 996–1004. PMC 1477018. PMID 5845595.
  5. Kaneko E, Hoshihara Y, Sakaki N, Harasawa S, Ashida K, Asaka M; et al. (2000). "Peptic ulcer recurrence during maintenance therapy with H2-receptor antagonist following first-line therapy with proton pump inhibitor". J Gastroenterol. 35 (11): 824–31. PMID 11085491.


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