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§»êÁßȰ¡ 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.