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Gut Jul 1970Twenty-five cases of benign giant duodenal ulcer have been studied. In every case a barium meal examination showed an ulcer crater with a radiographic diameter of at...
Twenty-five cases of benign giant duodenal ulcer have been studied. In every case a barium meal examination showed an ulcer crater with a radiographic diameter of at least 2 centimetres. Abdominal pain was the commonest symptom but less than half of the patients had had pain characteristic of chronic peptic ulcer. Haemorrhage from the ulcer occurred in a large majority of them. The radiological appearances are described, and it has been shown that the giant ulcer may be missed through being mistaken for the duodenal cap or else misdiagnosed.It appears that the death rate in this condition has been falling but it is still high. The management of patients with giant ulcers is discussed.
Topics: Adolescent; Adult; Aged; Diagnosis, Differential; Diverticulum; Duodenal Ulcer; Duodenum; Female; Gastrectomy; Humans; Male; Middle Aged; Pain; Peptic Ulcer; Peptic Ulcer Hemorrhage; Radiography; Vagotomy
PubMed: 4989052
DOI: 10.1136/gut.11.7.592 -
The Yale Journal of Biology and Medicine 1994Dragstedt believed that basal hypersecretion of gastric acid was the root cause of duodenal ulcer, that the hypersecretion was due to an increased vagal stimulation, and... (Review)
Review
Dragstedt believed that basal hypersecretion of gastric acid was the root cause of duodenal ulcer, that the hypersecretion was due to an increased vagal stimulation, and that vagotomy would therefore cure duodenal ulcer. He introduced vagotomy and demonstrated that the operation was successful in curing most patients of their duodenal ulcers. This article reviews how further research in the succeeding half century has demonstrated that it is the effect of vagotomy on stimulated, rather than upon basal secretion that cures duodenal ulcer and that the apparent basal hypersecretion of patients with duodenal ulcer is due to an increased parietal cell mass. The article points out that there is no convincing explanation as yet of the mechanism whereby vagotomy reduces histamine-stimulated gastric secretion.
Topics: Duodenal Ulcer; Gastric Acid; Humans; Vagotomy
PubMed: 7502527
DOI: No ID Found -
World Journal of Gastroenterology Jun 2015Peptic ulcer disease is a multifactorial and complex disease involving gastric and duodenal ulcers. Despite medical advances, the management of peptic ulcer and its... (Review)
Review
Peptic ulcer disease is a multifactorial and complex disease involving gastric and duodenal ulcers. Despite medical advances, the management of peptic ulcer and its complications remains a challenge, with high morbidity and death rates for the disease. An accumulating body of evidence suggests that, among a broad reach of natural molecules, dietary polyphenols with multiple biological mechanisms of action play a pivotal part in the management of gastric and duodenal ulcers. The current review confirmed that dietary polyphenols possess protective and therapeutic potential in peptic ulcer mediated by: improving cytoprotection, re-epithelialization, neovascularization, and angiogenesis; up-regulating tissue growth factors and prostaglandins; down-regulating anti-angiogenic factors; enhancing endothelial nitric oxide synthase-derived NO; suppressing oxidative mucosal damage; amplifying antioxidant performance, antacid, and anti-secretory activity; increasing endogenous mucosal defensive agents; and blocking Helicobacter pylori colonization associated gastric morphological changes and gastroduodenal inflammation and ulceration. In addition, anti-inflammatory activity due to down-regulation of proinflammatory cytokines and cellular and intercellular adhesion agents, suppressing leukocyte-endothelium interaction, inhibiting nuclear signaling pathways of inflammatory process, and modulating intracellular transduction and transcription pathways have key roles in the anti-ulcer action of dietary polyphenols. In conclusion, administration of a significant amount of dietary polyphenols in the human diet or as part of dietary supplementation along with conventional treatment can result in perfect security and treatment of peptic ulcer. Further well-designed preclinical and clinical tests are recommended in order to recognize higher levels of evidence for the confirmation of bioefficacy and safety of dietary polyphenols in the management of peptic ulcer.
Topics: Diet; Dietary Supplements; Duodenal Ulcer; Humans; Polyphenols; Risk Factors; Stomach Ulcer; Treatment Outcome
PubMed: 26074689
DOI: 10.3748/wjg.v21.i21.6499 -
World Journal of Gastroenterology Aug 2011This paper pays a tribute to Dr. Frank I Tovey on his 90th birthday which happens on September 1, 2011, and briefly describes the major findings in his research career...
This paper pays a tribute to Dr. Frank I Tovey on his 90th birthday which happens on September 1, 2011, and briefly describes the major findings in his research career and contributions as follows. The geographical prevalence of duodenal ulceration is related to staple diets. Unrefined wheat and maize, soya, certain pulses and millets are associated with a low prevalence while refined wheat, maize and rice, yams, cassava and green banana with a high prevalence. Predominant foodstuffs from low prevalence areas are ulceroprotective in rat peptic ulcer models. The protective activity lies in the lipid fraction present in these foodstuffs. The lipid fraction also promotes ulcer healing, is active both orally and intramuscularly and is ulceroprotective against non-steroidal anti-inflammatory drugs (NSAIDs). The phospholipids and phytosterols present in the lipid have been identified to be responsible for this protective activity. The combination of phospholipids and phytosterols may be of value in the prevention and treatment of duodenal ulceration and protection against the ulcerogenic effect of NSAIDs.
Topics: Animals; Diet; Duodenal Ulcer; Humans; Research Personnel
PubMed: 21987600
DOI: 10.3748/wjg.v17.i31.3565 -
British Medical Journal Sep 1969
Topics: Alkalies; Animals; Diet Therapy; Duodenal Ulcer; Gastric Juice; Humans; Hydrogen-Ion Concentration; Milk
PubMed: 5394605
DOI: No ID Found -
British Medical Journal Nov 1969
Topics: Diet Therapy; Duodenal Ulcer; Humans; Male; Naval Medicine; Peptic Ulcer
PubMed: 5345944
DOI: 10.1136/bmj.4.5678.299-b -
British Medical Journal Nov 1969
Topics: Diet Therapy; Duodenal Ulcer; Food Preferences; Food-Processing Industry; Humans
PubMed: 5345945
DOI: 10.1136/bmj.4.5678.299-c -
Alimentary Pharmacology & Therapeutics Oct 2009Helicobacter pylori infection rates in duodenal ulcer (DU) patients may be lower than previously estimated. (Review)
Review
BACKGROUND
Helicobacter pylori infection rates in duodenal ulcer (DU) patients may be lower than previously estimated.
AIM
To review the real prevalence of H. pylori-negative DUs and its possible causes.
METHODS
Bibliographical searches in MEDLINE looking for the terms 'H. pylori' and 'duodenal ulcer'.
RESULTS
Mean prevalence of H. pylori infection in DU disease, calculated from studies published during the last 10 years including a total of 16 080 patients, was 81%, and this figure was lower (77%) when only the last 5 years were considered. Associations with H. pylori-negative DU were: (1) False negative results of diagnostic methods, (2) NSAID use (21% in studies with <90% infection rate), (3) Complicated DU (bleeding, obstruction, perforation), (4) Smoking, (5) Isolated H. pylori duodenal colonization, (6) Older age, (7) Gastric hypersecretion, (8) Diseases of the duodenal mucosa, (9) Helicobacter'heilmanii' infection and (10) Concomitant diseases.
CONCLUSION
In patients with H. pylori-negative DU disease, one should carefully confirm that the assessment of H. pylori status is reliable. In truly H. pylori-negative patients, the most common single cause of DU is, by far, the use of NSAIDs. Ulcers not associated with H. pylori, NSAIDs or other obvious causes should, for the present, be viewed as 'idiopathic'. True idiopathic DU disease only exceptionally exists.
Topics: Anti-Inflammatory Agents, Non-Steroidal; Duodenal Ulcer; Epidemiologic Methods; False Negative Reactions; Helicobacter Infections; Helicobacter pylori; Humans; Proton Pump Inhibitors
PubMed: 19706147
DOI: 10.1111/j.1365-2036.2009.04105.x -
Clinica Chimica Acta; International... Jul 2020A 73-year-old man was displaying symptoms of massive gastrointestinal (GI) bleed. Surgical actions were performed to control the bleed caused by an erosive duodenal...
A 73-year-old man was displaying symptoms of massive gastrointestinal (GI) bleed. Surgical actions were performed to control the bleed caused by an erosive duodenal ulcer with duodenal perforation. When investigating the culprit of this case, the pain medications prescribed two weeks prior by a traditional Chinese medicine doctor raised attention. The patient's admission serum sample and the pain medications from unknown sources were analyzed using a clinically validated liquid chromatography-high-resolution mass spectrometry (LC-HRMS) method. The NSAIDs diclofenac, piroxicam, and indomethacin were identified, as well as some other synthetic drugs and natural products. The patient's concurrent exposure to multiple NSAIDs significantly increased the risk of upper GI complications. It is reasonable to argue that the high-dose use of the NSAIDs was a major cause of the duodenal ulcer and GI bleed. In addition, the identified natural products such as atropine and ephedrine have well-documented toxicities. It is important to increase the visibility of unregulated medications, and the capability to perform untargeted mass spectrometry analysis provides a unique diagnostic advantage in cases where exposure to toxic substances is possible.
Topics: Aged; Anti-Inflammatory Agents, Non-Steroidal; Chromatography, Liquid; Duodenal Ulcer; Gastrointestinal Hemorrhage; Humans; Male; Mass Spectrometry
PubMed: 32234495
DOI: 10.1016/j.cca.2020.03.037 -
Journal of Feline Medicine and Surgery Oct 2022The aim of this study was to describe the endoscopic appearance of gastroduodenal ulcers (GDUs), and to assess the clinical, ultrasonographic and histological data, as...
OBJECTIVES
The aim of this study was to describe the endoscopic appearance of gastroduodenal ulcers (GDUs), and to assess the clinical, ultrasonographic and histological data, as well as long-term follow-up, in cats.
METHODS
The medical record databases of five veterinary endoscopists were evaluated between January 2016 and 2020, in a retrospective study. Cats with at least one gastric or duodenal ulcer detected by endoscopic examination were included. All the medical records of the selected cats were reviewed and information was collected regarding breed, age, sex, neuter status, medical history, clinical signs, and ultrasonographic, endoscopic and histological findings. The cats were evaluated at 6, 12 and 18 months.
RESULTS
Sixty-one cats with a median age of 9.0 years (range 2.0-16.0) were included in the study. The most common complaints were vomiting (n = 55; 90%) and hyporexia (n = 40; 66%); haematemesis was reported in 12 (20%) cats. Endoscopy showed GDUs in the following locations: gastric body in 28 cats (46%), antropyloric area in 34 cats (56%), fundus in 13 cats (21%) and duodenum in eight cats (13%). A single GDU was found in 42 cats (69%) and multiple GDUs were seen in 19 cats (31%). Histopathological evaluation revealed benign lesions in 33 (54%) cats and malignant lesions in 28 (46%; 24 high-grade lymphoma, one low-grade lymphoma and three carcinoma). High-grade lymphoma was detected only in the stomach. Cats diagnosed with malignant GDUs (median 10.5, range 4-16) were significantly older than cats with benign lesions ( = 0.002).
CONCLUSIONS AND RELEVANCE
GDUs are common and were detected in 5.1% of cats undergoing an upper gastrointestinal endoscopy. The risk of a malignant ulcer increases proportionally with each year of increasing age. GDU location, number and morphological appearance do not provide any indication of the nature of the ulcer; however, duodenal ulcers are frequently benign. Endoscopic examination facilitates the early and minimally invasive detection of GDUs in cats.
Topics: Animals; Cat Diseases; Cats; Duodenal Ulcer; Duodenum; Lymphoma, Non-Hodgkin; Retrospective Studies; Ulcer
PubMed: 35848606
DOI: 10.1177/1098612X221109802