Review Question - QID 106086

This patient has epigastric and abdominal pain that improves immediately after eating, and he is found by endoscopy to have a duodenal ulcer. The most common complication of duodenal ulcers is hemorrhage.

Duodenal ulcers are caused by damage to the intestinal mucosa. Duodenal ulcers are often due to acid hypersecretion and are associated with H. pylori in over 90% of cases. Other causes include NSAID use, corticosteroids, tobacco, and alcohol. Duodenal ulcers typically present with chronic, dull, burning epigastric pain that improves with meals but worsens 1 to 3 hours afterwards. Complications of duodenal ulcers include hemorrhage, obstruction, intractable pain, and perforation.

Ramakrishnan and Salinas discuss peptic ulcer disease, particularly gastric and duodenal ulcers. They state that, while peptic ulcer disease typically occurs in the stomach and proximal duodenum, it may also affect the lower esophagus, the distal duodenum, and the jejunum. H. pylori infection is a major cause of peptic ulcer disease in the United States. They recommend treatment of H. pylori if it is detected, as eradication reduces recurrence of duodenal ulcers from 67 to 6 percent and of gastric ulcers from 59 to 4 percent.

O'Connor et al. review the treatment of H. pylori. The first line therapy for H. pylori is triple therapy with a proton-pump inhibitor and two antibiotics, such as amoxicillin and clarithromycin. Patients should receive therapy for at least 14 days, as a Cochrane systematic review (3)found that increasing the duration of treatment increases H. pylori eradication. They predict that the treatment of H. pylori will migrate towards individualized therapy that takes into account available data regarding the antimicrobials, resistance trends, as well as CYP2C19 metabolism.

Figure A reveals a duodenal ulcer.

Incorrect answers:
Answers 1, 3-5: Although all of these are possible complications of a duodenal ulcer, the most common complication is hemorrhage.