Gastric and duodenal ulcers презентация

Checked by:Sainova M.B
Prepared by:Beken O.SH
Faculty:GM
Course:2
Group:027-2





Almaty,2017

books

wall

Duodenum (1st part small intestine) – most common site

“Gastric” ulcers – in stomach

Pain, bloating, nausea, “fullness”, weight loss, tiredness
Complications: bleeding, perforation, obstruction

H. pylori
GI series (rare)

False positive tests
Missed cases? – risk of transmission / disease progression

from chronic burden
Potential “medical emergency”
Chronic symptoms – health and economic costs
H. pylori also linked to:
Functional dypepsia
Cancer (2-6x more likely, though still rare)
Differential clinical outcome - interaction between bacterial properties (phenotypic variation), genetics and environmental / behavioural factors

AVERAGES IMPLICATIONS FOR CARE OF OLDER PEOPLE

(Bardhan et al. 2004, Digestive & Liver Disease 36(9), 577-588)

types given to worry and irritability (Robinson & Bruce 1940)

increase risk – smoking, physical stress, salt (GU)
Genetic susceptibility / protection against H. pylori infection (twin studies, mouse models)
Rarely…Zollinger-Ellison syndrome & others

therapy clears most cases (74% duodenal ulcers)
Relapse greater for gastric ulcers (affected by lifestyle factors). At 3-12 months:
Duodenal ulcers: 39% clear (acid suppression only); 91% (combination therapy)
Gastric ulcers: 45% clear (acid suppression only); 77% (combination therapy)

complications, surgery

Tertiary care – rarely needed

Socio-economic cost: Standardised average annual years of life lost (up to age 75) = 2.6 (per 10,000) (Females=1.8; Males=3.5) (1999 & 2001 pooled data, ONS)

we need to know how to target prophylaxis.” (Calam & Baron 2001)

Ulcers occurring in absence of H. pylori or NSAIDs / aspirin. Combination therapies less effective in absence of H. pylori – data needed

Screening? Cost-effective cost/LYS < £10,000 over 80yrs. But effects of eradication on morbidity / mortality?

Increase in H.pylori?
Different strain of H. pylori?
Another concurrent gut infection?

But what about differing temporal changes of CU and DU and between men and women?

al. 1994)
Decreased hospitalized morbidity and mortality
Related more to changes in risk factors (e.g. smoking) in different cohorts than new pharmacological treatments? - implications for public health!

OR: Genetic factors may be more important (Malaty et al. 1994)

(HPA)
Prevalence infection: 40% population (HPA: >50% of 50+yr olds)

Ulceration
Incidence:
DU in 30-50yrs old; higher incidence in men
GU in >60yr olds; higher incidence in women
Low prevalence in younger age groups
Duodenal ulcer: up to 10% of population

particularly deprived areas (men 3.3/1000 - 1.5/1000; women 1.8/1000 - 0.9/1000)
Sex incidence evening out – decreasing incidence in young men; increasing in older women
But emergency admission rates for complications unchanged in last 30yrs
Kang et al. (2006) – increase in case fatality for DU. Due to concomitant comorbidity / increasing ulceration (NSAIDs) / H.pylori (i.e. changing natural history)?
Future decrease in prevalence?

travel?

H. pylori - oral / faeco-oral transmission associated with poverty / overcrowding in childhood

Increased prevalence in children with history of ulcer in the mothers – due to common environmental factors?

Variation between ethnic groups even within countries

specific death rates (per 100,000 European standard population) - regional centres higher than national average
High rates affected by lifestyle factors & e.g. aspirin in deprived areas (raised CVD risk)?

Lowest = E. Midlands (89). Highest = London (112)
Industrial areas = 114, London suburbs = 111, London cosmopolitain = 153

certification)
Numerator - mortality data 1993-2006 (ONS) with codes assigned using postcode of usual residence
Changes to coding causes of death in England & Wales. Data based on new coding
Denominator data - latest revisions of ONS mid-year population estimates, current at Oct 2007 - quite accurate
NCHOD regularly updated

is main cause but has changing natural history
“Each generation has carried its own particular risk of bearing ulcers throughout adult life” (Susser & Stein 1962)
Current pattern = exposure to H. pylori + genetics + exposure to drugs + environmental / behavioural factors
DU / GU likely to continue causing significant chronic disease burden and personal / societal cost. Predicting future pattern difficult

2016.
"Basic TB Facts". CDC. March 13, 2012. Retrieved 11 February 2016
Medical Laboratory Science: Theory and Practice. New Delhi: Tata McGraw-Hill. 2000. p. 473
"Acid-Fast Stain Protocols". 21 August 2013. Retrieved 26 March 2016.
Wkipedia.org