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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.
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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.
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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.
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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 ...