Peptic ulcer classification

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Manpreet Kaur, MD [2]

Overview

Peptic ulcer disease may be classified into two types based on the location within the gastrointestinal tract. gastric ulcer and duodenal ulcer. Gastric ulcers are present mostly at lesser curvature of the stomach while Duodenal ulcers are mostly present at the duodenal bulb.

Classification

Peptic ulcer disease may be classified according to location into two subtypes: ^[1]^[2]

Classification and prevalences of stigmata of recent hemorrhage of peptic ulcer using endoscopy*
Stigmata of hemorrhage	Forrest classification	Prevalence
Active spurting bleeding	IA	12%(spurting+oozing)
Active oozing bleeding	IB
Non-bleeding visible vessel	IIA	8%
Adherent clot	IIB	8%
Flat pigmented spot	IIC	16%
Clean base	III	55%

*Adopted:American college of gasteroenterology^[3]

Gastric ulcer

Gastric ulcer is further divided on the basis of location and endoscopic findings:

Gastric ulcer is further classified into 3 subtypes depending upon their location:^[4]^[5]^[6]
- Type 1: Ulcer present at the body of stomach without involving duodenum, pylorus or prepyloric region and not associated with hypersecretion of gastric acid
- Type 2: Ulcer present at the body of stomach combined with duodenum and associated with gastric acid hypersecretion
- Type 3: Ulcer close to pylorus and associated with gastric acid hypersecretion

Gastric ulcer classification by using endoscopic staging system of Sakita into three stages:^[7]
- Active
- Healing
- Scarring

ACTIVE STAGE
A1	Surrounding mucosa is found to be edematously swollen and there is no regenerating epithelium seen on endoscopy
A2	Surrounding mucosa is less edematous, a small amount of regenerating epithelium is seen at the ulcer margin A red halo in the marginal zone, a white slough circle and converging mucosal folds t the ulcer margin are frequently seen
HEALING STAGE
H1	The white coating is becoming thin and the regenerating epithelium is extending into the ulcer base The gradient between the ulcer margin and the ulcer floor is becoming flat The ulcer crater is still evident and the margin of the ulcer is sharp The diameter of the mucosal defect is about one-half to two thirds that of A1
H2	The defect is smaller than in H1 and the regenerating epithelium covers most of the ulcer floor. The area of white coating is about a quarter to one-third that of A1
SCARRING STAGE
S1	The regenerating epithelium completely covers the floor of the ulcer The white coating has disappeared Initially, the regenerating region is markedly red but upon close observation, many capillaries can be seen and this is called ‘‘red scar’’
S2	In several months to a few years, the redness is reduced to the color of the surrounding mucosa and this is called ‘‘white scar’’

References

Overview