Which one of the following statements regarding peptic ulceration is not correct?
Gastric ulcers are more common than duodenal ulcers.
The statement that is not correct is that gastric ulcers are commoner than duodenal ulcers. In fact duodenal ulcers are far commoner, classically about 4:1. Duodenal ulcers affect a younger age group, are strongly linked to Helicobacter pylori (about 90 per cent of cases) and high acid output, and cause hunger pain relieved by food; gastric ulcers occur in older patients, reflect failure of mucosal defence and NSAID use, and pain is aggravated by food.
The other statements are true. H. pylori or NSAIDs do account for the overwhelming majority, with Zollinger-Ellison syndrome, smoking and steroids being rare contributors. Gastric ulcers may be malignant - an ulcerated carcinoma can mimic a benign ulcer, so every gastric ulcer needs multiple edge biopsies and endoscopic confirmation of healing; duodenal ulcers are virtually never malignant. Antisecretory agents plus eradication (PPI with triple or quadruple regimens) are indeed the mainstays, making elective ulcer surgery rare.
Key point: Duodenal ulcer is commoner and never malignant; gastric ulcer is less common but must always be biopsied to exclude carcinoma.
Important Questions from Stomach
- The most common metabolic abnormality associated with gastric outlet obstruction is
- Which of the following statements about peptic ulcers is correct?
- A 50 year old male patient presents to the emergency with sudden onset of upper abdominal pain, nausea, vomiting and haematemesis. On examination, PR = $106$/min, BP = $100/70$ mm Hg and pallor is present. CECT abdomen reveals a large exophytic tumor of size $13 \times 8$ cm at the fundus of the stomach. On upper GI endoscopy, the mucosa overlying the tumor is intact. The staining for CD117 in the upper GI endoscopic biopsy is positive. The most probable clinical diagnosis in this patient is
- A gentleman of 36 years presented with a long history of upper abdominal pain which was periodic and often occurred early morning. For last 3 months, he is having projectile vomiting, which is non bilious, unpleasant in nature with undigested food materials. On examination he appears unwell, dehydrated and seemed to have lost weight. Probably he is suffering from:
- All of the following are sequelae of peptic ulcer surgery EXCEPT:
