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Tuesday, 26 November 2013

Duodenal ulcers : The Complications

Duodenal ulcers, a type of peptic ulcer is defined as a condition of a localized tissue erosion in the lining  the duodenum as a result of bacteria Helicobacter pylori (H pylori) in most cases. According to the study by Department of Research, University Hospital, Basel, fasting gastrin and pepsinogen-I and -II concentrations were significantly higher in H pylori positive compared with H pylori negative subjects. Neither age nor sex affected basal gastrin and pepsinogen concentrations in H pylori negative subjects. Fasting gastrin, pepsinogen-I and -II concentrations in serum samples were similar in H pylori positive persons with no symptoms and those with duodenal ulcers suggesting that similar mechanisms are involved in increasing plasma concentrations of these variables in both populations. Hypergastrinaemia and hyperpepsinogenaemia are therefore probably secondary to active H pylori.
C. Complications
1. Peptic ulcer bleeding 

Peptic ulcer bleeding is a frequent and dramatic event with both a high mortality rate and a substantial cost for healthcare systems worldwide. It has been found that age is an independent predisposing factor for gastrointestinal bleeding, with the risk increasing significantly in individuals aged>65 years and increasing further in those aged>75 years. Indeed, bleeding incidence and mortality are distinctly higher in elderly patients, especially in those with co-morbidities(12).
2. Perforative hole
In the study of Diagnosis and the results of surgical treatment of perforated gastroduodenal ulcers, showed that the excellent and good long-term results after closure of a perforative hole were noted in 11.7% of the patients, after vagotomy–in 91.6% after gastric resection–in 88%(13). Other indicated that
Complications of gastric and duodenal ulcers were hematemesis and hematochezia (n = 20, 33.3%), and perforation (n = 2, 3.3%)(14).
3. Ulcer scars
Scar tissue produced by peptic ulcers  can block passage of food through the digestive tract. There is a study of 181 patients with a gastroduodenal ulcer or ulcer scar (102 with a gastric lesion, 60 with a duodenal lesion, and 19 with both sites involved), specimens were cultured for H. pylori and TTV infection was sought in serum by a polymerase chain reaction(15).
4. Etc.
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Sources
(1) http://www.ncbi.nlm.nih.gov/pubmed/8314506
(12) http://www.ncbi.nlm.nih.gov/pubmed/17896831
(13) http://www.ncbi.nlm.nih.gov/pubmed/1881067
(14) http://www.ncbi.nlm.nih.gov/pubmed/9059054 
(15) http://www.ncbi.nlm.nih.gov/pubmed/11192317