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Staging of Ulcers

written by: Norene A • edited by: lrohner • updated: 2/24/2011

Knowing how and what type of ulcers are staged helps to understand what kind of treatment to expect. Read this article for an overview of gastrointestinal ulcers.

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    What Are Peptic Ulcers?

    Locations for a peptic ulcer include the inner lining of the stomach, known as a gastric ulcer; the lining of the small intestine, or duodenum, known as a duodenal ulcer; and the lining of the esophagus, known as an esophageal ulcer. As the protective layer is broken down, the hydrochloric acid in the digestive juices causes damage to the esophagus, stomach or intestinal tissue. The most common types of ulcer are the duodenal and gastric.

    The most common causes for peptic ulcers, according to the National Digestive Diseases Information Clearinghouse, are the Helicobacter pylori (H. pylori) bacteria and nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and aspirin.

    Symptoms of an ulcer may include stomach pain or burning, nausea, poor appetite and weight loss. Sudden sharp stomach pain and bloody stools or vomit could indicate an ulcer has perforated the stomach or duodenal wall or broken through a blood vessel. This is an emergency, and you should seek medical treatment right away.

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    Peptic Ulcer Staging by Sakita

    The World Journal of Gastrointestinal Endoscopy identifies what type of ulcers are staged using a six-stage system by Sakita. These stages are divided into three stages of two levels as follows:

    Active Stage

    • A1 -- This identifies an ulcer containing a mucus coating that has swelling around the margin.
    • A2 -- While the ulcer margin is clear, the mucus-coated ulcer has less swelling than A1.

    Healing Stage

    • H1 -- Healing has begun with regenerating epithelium covering the ulcer base.
    • H2 -- A mucosal break remains, but most of the ulcer is covered with regenerating epithelium.

    Scarring Stage

    • S1 -- As the scarring stage begins, the regenerating epithelium completely covers the ulcer bed. The white coating of the ulcer has been replaced by a red scar.
    • S2 -- Complete re-epithelialization occurs over a period of months to years and replaces the redness with a white scar.

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    Peptic Ulcer Treatment

    Peptic ulcer treatment depends on the cause. If your ulcer is from an H. pylori infection, the treatment is to prescribe an antibiotic. Be sure to take all your prescription as directed, and follow up with your doctor for a test to make sure the infection is gone. A proton pump inhibitor may be prescribed to reduce the amount of stomach acid produced.

    For stomach ulcers from the use of NSAIDs, you may be asked to reduce or stop taking the NSAID and change to a different type of medicine less likely to cause ulcers.

    Most ulcers will go through the ulcer stages and completely heal. Possible reasons for the failure of a gastric ulcer to heal include tobacco use, extreme production of stomach acid, diseases such as Crohn's disease, regular use of some pain relievers and stomach cancer, according to the Mayo Clinic.

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    References

    National Digestive Diseases Information Clearinghouse: What I Need to Know about Peptic Ulcers http://digestive.niddk.nih.gov/ddiseases/pubs/pepticulcers_ez/#2

    World Journal of Gastrointestinal Endoscopy: Gastric Ulcer Stages http://www.wjgnet.com/1948-5190/full/v2/i1/36-T1.htm

    Mayo Clinic: Peptic Ulcer http://www.mayoclinic.com/health/peptic-ulcer/DS00242/DSECTION=treatments-and-drugs

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