Chapter 409

The terms acid peptic diseases, peptic diseases, or acid-related disorders are used synonymously to describe conditions that involve gastric acid and pepsin in their pathogenesis; they refer to a number of disorders including esophagitis, gastritis, peptic ulcer disease, and duodenitis. Gastritis is a condition diagnosed histologically, not clinically or radiologically.1-5 It is characterized by the presence of inflammatory cells and is often found to be present in biopsies taken from gastric mucosa that appears normal at endoscopy. Some forms of chronic, severe gastritis may destroy mucosal elements, resulting in atrophic gastritis and intestinal metaplasia, which in some forms may be preneoplastic. Although gastritis and ulcer disease may occur as stand-alone entities, they are often part of a continuum of disease.2,3,6 A special case is that of Helicobacter pylori, an important cause of gastritis and peptic ulcer disease discussed separately.

Gastropathy refers to those entities in which inflammation is not a prominent feature, although there is often epithelial damage and regeneration, and perhaps vascular abnormalities. Gastropathies often have a typical endoscopic appearance (eg, portal hypertensive gastropathy, prolapse gastropathy) but are not usually associated with biopsy evidence of inflammatory infiltrate.

### Epidemiology

Peptic ulcer and gastritis are uncommon in infants and young children. Peptic disorders are far less prevalent in the pediatric age group overall than in adults, accounting for probably no more than 10% to 20% of children seeking medical attention for abdominal pain even in a subspecialty gastrointestinal (GI) outpatient clinic setting.7 In adults, there has been a profound decline in the frequency of uncomplicated peptic ulcer disease. In contrast, there has been a relative increase in complicated disease which may be due to increasing use of nonsteroidal anti-inflammatory drugs (NSAIDs) and an aging population.

A number of factors are alleged to cause or predispose to peptic ulcer disease.8Helicobacter pylori and NSAIDs are recognized as the major causes of peptic ulcer disease in adults. Familial clustering is most commonly due to H pylori but in non–H pylori peptic ulcer disease there may be a genetic disposition for peptic ulcer disease, as suggested by studies on concordant twins. Certain HLA subtypes, or carriers of certain blood group antigens, also appear to be at increased risk. A strong association exists between chronic pulmonary disease in adults and peptic ulceration that may be related to cigarette smoking. Cigarette smoking predisposes to ulcer formation and complications, probably by inhibiting prostaglandin synthesis and thereby compromising preepithelial or mucosal integrity. Peptic ulcer disease is associated with hepatic cirrhosis and chronic renal disease. There is no evidence that any dietary factors contribute to peptic ulcer disease, although spicy foods may cause dyspepsia in some individuals. Coffee, tea, and cola are potent acid secretagogs, but no link to peptic ulceration has been established. Decaffeinated coffee is as potent a secretagog as caffeinated coffee. Emotional stress alone, without the contribution of H pylori ...

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