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Duodenal ulcer

95%°¡ 1st portion¿¡ ¹ß»ýÇϸç 90%°¡ pylorus¿Í duodenal mucosa jxÀÇ 3cm³»¿¡ Á¸ÀçÇÑ´Ù.

ÇöÀç Àα¸ÀÇ 10%°¡ DU¸¦ °æÇèÇϸç Ä¡·áÇÏÁö ¾ÊÀº DUÀÇ natural history´Â spontaneous

healing & recurrence¸¦ º¸ÀδÙ.

60%°¡ 1³â³» Àç¹ßÇϰí 80-90%°¡ 2³â³» Àç¹ßÇÑ´Ù.

1. ¿øÀÎ ¹× º´ÀÎ

DUÀÇ 95-100%, GUÀÇ 75-85%°¡ H.pylori¾ç¼ºÀÌ´Ù.

ÀÌÀü¿¡ °¨¿°µÈ H.pylori°¡ DU, GU risk¸¦ Áõ°¡½Ã۸ç

IgG Ab levelÀº DU, GU positivity risk¿Í ºñ·ÊÇÑ´Ù.

±×·¯³ª H. pylori¿¡ °¨¿°µÈ »ç¶÷ÀÇ 15-20%¿¡¼­¸¸ ulcer°¡ ¹ß»ýÇÑ´Ù.

2. H. pylori - H. pyloriÆí ÂüÁ¶

3. Other pathogenic facters

1) somatostatin deficiency

H. pylori infection¶§ Ãʱ⿡´Â À§»êºÐºñ°¡ ÀϽÃÀûÀ¸·Î Áõ°¡ÇÏ¿´´Ù°¡ ¼ö°³¿ùµ¿¾È

hypochlorhydria»óŰ¡ µÇ¾ú´Ù°¡ 1³â³» °¨¿°ÀüÀÇ ¼öÁØÀÌ µÈ´Ù.

H.pylori infectionȯÀÚ¿¡¼­ gastrinºÐºñ°¡ Áõ°¡µÇ´Â ±âÀüÀ¸·Î somatostatin deficiency

°¡ ¼³¸íµÇ´Âµ¥ H. pylori infectionȯÀÚ´Â somatostatin levelÀÌ ¶³¾îÁ® ÀÖ´Ù.

2) Cigarette smoking

DU incidence¡è

DU therapy¿¡ ´ëÇÑ response¡é

gastric acid secretionÀ» Áõ°¡½ÃŰÁö´Â ¾ÊÀ¸³ª

i) nicotine¿¡ ÀÇÇØ pancreatic bicarbonate°¡ ¾ïÁ¦µÇ°í DU incidence°¡ Áõ°¡

ii) ½ÊÀÌÁöÀå³»·Î À§»ê¹èÃâÀ» ÃËÁø½Ã۰í

iii) H. pylori infectionÀ» Á¶ÀåÇÑ´Ù.

3) others: CRF, alcoholic cirrhosis, renal transplantation, hyperparathyroidism

systemic mastocytosis, COPD

»ó±âȯÀÚ¿¡¼­ DU incidence°¡ ³ô´Ù.

4) chronic anxiety & psychosocial stress

DU pathogenesis¿¡ °ü¿©ÇÏ´Â °Í¿¡ ³í¶õÀÌ ÀÖ´Ù.

±×·¯³ª ulcer activityÀÇ ¾ÇÈ­¿¡ ±â¿©ÇÏ´Â ¿ä¼ÒÀÌ´Ù.

4. ÀÓ»óÀû Ư¡

1) mc sx : epi pain(sharp, burning)

½ÄÈÄ 1.5-3½Ã°£ÈÄ painÀÌ ¹ß»ý

¹ã¿¡ ÀáÀ» ±þ

½Ä»ç or Á¦»êÁ¦ º¹¿ë ¼öºÐ³» È£Àü

-> ½Ä»çÈÄ ÀϽÃÀûÀ¸·Î À§»êÁßÈ­°¡ µÇ¾ú´Ù°¡ rebound gastrinºÐºñ°¡ Áõ°¡

-> À§»êºÐºñ ÃËÁø

active DUÀÇ ¸¹Àº ȯÀÚ°¡ Áõ»óÀÌ ¾øÀ¸¸ç 1/2ÀÌ Áõ»ó¾øÀÌ Àç¹ßÇÑ´Ù.

2) PE : epi. tenderness

3) Pyloric channel ulcer

DU sx°ú À¯»çÇϸç À§»êºÐºñÀÇ Æ¯Â¡ÀÌ DU¿Í À¯»çÇϹǷΠDU·Î ºÐ·ùÇÑ´Ù.

Nonulcer dyspepsiaÀÇ pathogenesis¿¡ H. pylori infectionÀÌ ¿ªÇÒÀ» ÇÏ´Â °ÍÀ¸·Î

Áõ¸íµÇÁö ¾Ê¾Ò´Ù. 50%ȯÀÚ¿¡¼­ H. pylori infectionÀÌ ÀÖÀ¸¸ç ÀÌ´Â ÀϹÝÀα¸º¸´Ù

³ôÁö ¾Ê´Ù.

5. Áø´Ü

UGI, Endoscopy

* typical DUȯÀÚ ´ëºÎºÐÀº ÃÖ±Ù NSAID»ç¿ëº´·Â, gastric hypersecretory stateÀÇ

sx & sign, H.pylori eradicationº´·ÂÀÌ ÀÖ´Â °æ¿ì¿£ H.pyloriÀÇ specific diagnostic test°¡

ÇÊ¿äÄ¡ ¾Ê´Ù.

* ¼ö¼úÀ» °èȹÇϰųª underlying gastrinoma°¡ ÀǽɵǴ °æ¿ì¿¡ serum gastrin levelÀ»

checkÇÑ´Ù.