Peptic ulcer disease NSAID-related

Peptic ulcer disease (PUD) refers to a group of ulcerative disorders of the upper GI tract that require acid and pepsin for their formation. Ulcers differ from gastritis and erosions in that they extend deeper into the muscularis mucosa. The three common forms of peptic ulcers include Helicobacter pylori (HP)-associated ulcers, nonsteroidal antiinflammatory drug (NSAID)-induced ulcers, and stress-related mucosal damage (also called stress ulcers). 

The author commented that 50-75% of gastrocolic fistulas are related to benign gastric ulcers secondary to the use of NSAIDs. The use of aspirin plus prednisone, as in this patient, increases the risk of complication of peptic ulcer disease two- to fourfold. 

Gastric erosions are aphthous ulcers that do not penetrate the muscularis mucosa. They are most often related to H. pylori infection (Levine and Rubesin 1995). Other causative agents include alcohol, salicylates, and nonsteroidal anti-inflammatory drugs (NSAIDs). They are also seen in critically ill patients due to multiple trauma, sepsis, shock, etc. At double-contrast barium studies, gastric erosions appear as shallow small, 1-2-mm-diameter collections of barium surrounded by a radiolucent rim of oedema an appearance mirrored at endoscopy with a haemorrhagic centre and oedematous rim (Fig. 5.2a,b) (Levine and Rubesin 1995 Sohn et al. 1995 Dheer et al. 2002). H. pylori infection is also related to the presence of lymphoid follicular hyperplasia, which is commonly present in patients with peptic ulcer disease (Fig. 5.3a,b) (Torigian et al. 2001). 

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