Question
Which of the following statements regarding peptic ulcers are correct?
1. Duodenal ulcers are more common as compared to gastric ulcers.
2. Helicobacter pylori and NSAIDs are most common causative agents.
3. Bleeding is the most common complication associated with posterior duodenal ulcer.
Select the correct answer using the code given below.
The correct answer is
1, 2 and 3
Peptic Ulcer Statements: Analysis
This question tests three statements about peptic ulcers - their relative frequency, causative agents, and the characteristic complication of posterior duodenal ulcers. All three statements are factually correct.
Statement 1: Duodenal Ulcers vs Gastric Ulcers
Statement: Duodenal ulcers are more common as compared to gastric ulcers.
- Duodenal ulcers occur roughly 4 times more frequently than gastric ulcers.
- Duodenal ulcers typically affect a younger age group (30-55 years), whereas gastric ulcers occur more in older patients (55-70 years).
Verdict: Correct
Statement 2: Causative Agents
Statement: Helicobacter pylori and NSAIDs are the most common causative agents.
- H. pylori infection accounts for the majority of duodenal ulcers and a large proportion of gastric ulcers by disrupting the mucosal defense barrier.
- NSAID use is the second major cause, as these drugs inhibit protective prostaglandin synthesis (via COX-1 inhibition), impairing mucosal defence.
- Together, H. pylori and NSAIDs account for the overwhelming majority of peptic ulcer disease cases, with other causes (Zollinger-Ellison syndrome, stress ulcers, smoking) being far less common.
Verdict: Correct
Statement 3: Complication of Posterior Duodenal Ulcer
Statement: Bleeding is the most common complication associated with posterior duodenal ulcer.
- Duodenal ulcers on the posterior wall lie in close anatomical proximity to the gastroduodenal artery (which runs posterior to the first part of the duodenum).
- As these ulcers deepen, they characteristically erode into this artery, leading to hemorrhage/bleeding - which is why posterior duodenal ulcers are classically associated with bleeding as their most common and feared complication.
- In contrast, anterior duodenal ulcers are not backed by a major vessel; instead, they tend to perforate freely into the peritoneal cavity, so perforation is the complication classically linked with anterior ulcers, not posterior ones.
- This anterior-perforation / posterior-bleeding distinction is a well-established teaching point in surgery, so the statement as written is accurate for posterior duodenal ulcers specifically.
Verdict: Correct
Conclusion: Selecting the Correct Option
Since all three statements are correct:
- Statement 1 (duodenal > gastric ulcer frequency) - Correct
- Statement 2 (H. pylori and NSAIDs as leading causes) - Correct
- Statement 3 (bleeding as the classic complication of posterior duodenal ulcers due to gastroduodenal artery erosion) - Correct
The correct answer is 1, 2 and 3.
Why the Other Options Are Incorrect
- 2 and 3 only: Incorrectly excludes Statement 1, even though duodenal ulcers are well-documented to be more common than gastric ulcers.
- 1 and 3 only: Incorrectly excludes Statement 2, despite H. pylori and NSAIDs being the two leading, well-established causes of peptic ulcer disease.
- 1 and 2 only: Incorrectly excludes Statement 3. This option wrongly treats bleeding as not being the most common complication of posterior duodenal ulcers, overlooking the classic surgical association between posterior ulcers and gastroduodenal artery erosion causing hemorrhage.
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