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Return to: Twitter Facebook Linkedin Reddit Get Citation Citation AMA Citation Duodenal Ulcer. In: Doherty GM. Doherty G.M. Ed. Gerard M. Doherty.eds. Quick Answers Surgery New York, NY: McGraw-Hill; 2010. http://accesssurgery.mhmedical.com/content.aspx?bookid=853§ionid=49662072. Accessed June 22, 2017. MLA Citation . "Duodenal Ulcer." Quick Answers Surgery Doherty GM. Doherty G.M. Ed. Gerard M. Doherty. New York, NY: McGraw-Hill, 2010, http://accesssurgery.mhmedical.com/content.aspx?bookid=853§ionid=49662072. Download citation file: RIS (Zotero) EndNote BibTex Medlars ProCite RefWorks Reference Manager © Copyright Tools Search Book Top Return Clip Duodenal Ulcer + Essential Features Print Section + • Epigastric pain relieved by food or antacids• Epigastric tenderness• Normal or increased gastric acid secretion• Signs of ulceration on upper GI studies• Helicobacter pylori infection ++ Epidemiology + • More common in young and middle-aged patients (20-45 years old)• Men affected more often than women• 95% of ulcers occur within 2 cm of pylorus within the duodenal bulb• H pylori infection is principal cause of duodenal ulcer, making the duodenum more vulnerable to acid and pepsin• Prevalence of duodenal ulcer reflects prevalence of H pylori infection• Majority of patients infected with H pylori do not develop ulcer disease• Duodenal ulcers not associated with H pylori due mostly to NSAID use• Gastric acid secretion is characteristically elevated compared with normal + Clinical Findings Print Section ++ Symptoms and Signs + • Epigastric pain temporarily relieved by food, milk, or antacids• Nausea and vomiting may be present even in absence of obstruction• Back pain may be present if ulcer perforates through posterior duodenal wall• Localized epigastric tenderness may be present on physical exam• Many patients have few vague abdominal symptoms ++ Laboratory Findings + • Increased basal acid output (male, 5.5 mEq/h; female, 3.0 mEq/h)• Increased maximal acid output after stimulation by histamine or pentagastrin (male, 40 mEq/h; female, 30 mEq/h)• Fasting serum gastrin > 200 pg/mL suggests gastrinoma• Serum antibodies for H pylori• Antral biopsy showing H pylori infection (histology, urease) ++ Imaging Findings + • Esophagogastroduodenoscopy showing duodenal ulceration• Radiographic upper GI contrast study showing ulcer niche, duodenal deformity, and distortion of duodenal bulb + Diagnostic Considerations Print Section ++ Rule Out + • Zollinger-Ellison syndrome (gastrinoma) in patients with severe or refractory duodenal ulcer + Work-up Print Section + • History and physical exam• Endoscopic or radiographic evidence of duodenal ulceration• Evaluate for H pylori infection by serum testing for screening or endoscopic biopsy testing• Evaluate basal acid output and fasting serum gastrin in severe or refractory disease to exclude Zollinger-Ellison syndrome (gastrinoma) ++ When to Admit + • Free ulcer perforation• Ulcer bleeding• Severe duodenal obstruction + Treatment and Management Print Section + • Goals are reduction of acid secretion and eradication of H pylori infection ++ Surgery + • Parietal cell or truncal vagotomy with pyloroplasty• Antrectomy and vagotomy ++ Indications + • Intractibility and failure of medical treatment• Bleeding• Perforation• Duodenal obstruction ++ Contraindications + • Inadequate medical treatment ++ Medications + • H2 blockers• Proton pump inhibitors• Antacids• Treatment of H pylori infection ++ Treatment Monitoring + • Endoscopy to confirm ulcer healing• Resolution of symptoms ++ Complications + • Bleeding• Perforation• Obstruction ++ Prognosis + • 80% heal within 6 weeks when treated with H2 blockers• 80% recurrence within 1 year if H pylori not eradicated ++ Prevention + • Avoidance of H pylori infection + Resources Print Section ++ References ++Jamieson GG. Current indications for surgery in peptic ulcer disease. World J Surg. 2000;24:256. [PubMed: 10658057] ++Zittel TT et al. Surgical management of peptic ulcer disease today—indication, technique and outcome. LangenbecksArch Surg. 2000;385:84. [PubMed: 10796046] ++Leontiadis GI. et al. Systematic reviews of the clinical effectiveness and cost-effectiveness of proton pump inhibitors in acute upper gastrointestinal bleeding. Health Technology Assessment 2007 (Winchester, England). 11(51):iii-iv, 1-164. ++Ford AC. et al. Eradication therapy for peptic ulcer disease in Helicobacter pylori positive patients. Cochrane Database of Systematic Reviews, 2006; (2):CD003840.