Peptic Ulcer Disease

2764 Words Mar 19th, 2012 12 Pages
*PEPTIC ULCER DISEASE*
Brief Introduction * Peptic Ulcer is a break in the gastric or duodenal mucosa that arises when the normal mucosal defensive factors are impaired or are overwhelmed by aggressive luminal factors such as acid and pepsin. * Ulcers extend through the musvularis mucosae and are usually over 5 mm in diameter. * In the United States, there are about 500,000 new cases per year of peptic ulcer and 4 million ulcer recurrences; the lifetime prevalence of ulcers in the adult population is approximately 10%. * Ulcers occur five times more commonly in the duodenum, where over 95% are in the bulb or pyloric channel. In the stomach, benign ulcers are located most commonly in the antrum (60%) and at the junction of the
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Use of even low-dose aspirin (81-162 mg/d) leads to complications in 0.6-1.2% of patients each year. * H pylori infection increases the risk of ulcer disease and complications over threefold in patients taking NSAIDs or low-dose aspirin. It is hypothesized that NSAID initiation may potentiate or aggravate ulcer disease in susceptible infected individuals. * Celecoxib (and the other “coxibs”) are NSAIDs that preferentially inhibit cycloocygenase-2 (COX-2) – the principal enzyme involved in prostaglandin production at sites of inflammation – while providing relative sparing of cyclooxygenase-1 (COX-1), the principal enzyme involved in prostaglandin production in the gastroduodenal mucosa and gastric cytoprotection. * Of greater clinical importance, the risk of significant clinical events (obstruction, perforation, or sever bleeding) is approximately 0.7% in patients taking coxibs and 1.4% in patients taking nonselective NSAIDs – a relative risk reduction of 50%. * Concurrent use of low-dose aspirin appears to partially negate the mucosal-sparing effects of coxibs. Among patients taking low-dose aspirin, the risk of a serious clinical event was not significantly different between patients taking coxibs and standar NSAIDs. * A twofold increase in the incidence in cardiovascular complications (myocardial infarction, cerebrovascular infarction, and death) was detected in patients taking rofecoxib and valdecoxib compared with
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