Prof. Ashok Sundarraman, MS, FRCS, FICS*

Peptic ulcers occur in presence of Acid and Pepsin. The two main types are gastric and duodenal but they can also occur at GJ Stoma, lower end of esophagus and Meckels diverticulum with ectopic gastric mucosa. According to duration and complexity of symptoms they can be acute or chronic.

Acute Peptic Ulcers:

Etiology: Disruption of gastric mucosal barrier appears as multiple erosions. 50% of patients give history of NSAID/aspirin intake and classically they present with hemorrhage.

Pathology: Frequently multiple.

Stomach - They can occur in any part.

Duodenum - Almost always confined to first part.

Shallow punched out and seldom invade musclecoats unlikely to leave scars healing.

Clinical features: Short lived attacks of dyspepsia - not recognized. Haemetemesis - recognized.

Acute duodenal ulcer in anterior wall occasionally perforates. These acute lesions can progress to chronic ulcers.

Treatment:

• Cause must be removed.

• Medical management has good response.

• Blood - transfusions for haemetemesis.

• Dietetic irregularities to be corrected.

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