Peptic Ulcer (Johnson) Classification

1. 1 is Less
2. 2 is Two
3. 3 is Pre-
4. 4 is Door
5. 5 is 5 letter (NSAID)

gastric ulcer
TypeMnemonicLocationAcid hypersecretionComplicationsSurgery
I (55%)LessLesser curvatureNoBleeding uncommonDistal gastrectomy with BI, BII or RY GJ anastomosis
II (20%)Two1 gastric + 1 duodenal or pre-pyloricYesBleeding, perforation, obstructionAntrectomy or Distal gastrectomy with BI, BII or RY GJ anastomosis+ Vagotomy
III (20%)PrePre-pyloricYesBleeding, perforationAntrectomy BI, BII or RY GJ anastomosis + Vagotomy
IV (<5%)DoorGastroesophagealNoBleedingSubtotal gastrectomy with RY GE anastomosis
V (<5%)5 letter (NSAID)AnywhereNoBleeding, perforation
Surgery is for emergent complications of PUD (e.g., obstruction and perforation) and bleeding refractory to endoscopic intervention or persistent disease despite medical therapy.
BI = Billroth I – gastroduodenal anastomosis
BII = Billroth II – gastrojejunal anastomosis
RY GJ anastomosis = Roux-en-Y Gastrojejunal anastomosis
RY GE anastomosis = Roux-en-Y Gastroesophageal anastomosis

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