Digestive Diseases and Sciences

, Volume 25, Issue 9, pp 660–672 | Cite as


A broader concept of peptic ulcer disease
  • R. Greenlaw
  • D. G. Sheahan
  • V. DeLuca
  • D. Miller
  • D. Myerson
  • P. Myerson
Original Articles


To evaluate the frequency and type of gastroduodenal mucosal inflammatory changes in patients with symptomatic acid peptic disease and nonulcer dyspepsia, 100 patients with gastrointestinal symptoms indicative of acid peptic disease or dyspepsia and 10 control subjects were clinically evaluated and underwent radiographic, endoscopic, and biopsy studies of the stomach and duodenum. Clinical evaluation revealed that of the 100 patients, 61% had classic and 39% had atypical manifestations of acid peptic (ulcer) disease. Endoscopic and histologic evaluation revealed that 25 patients had peptic ulcer craters, 86–90% of whom had associated gastroduodenitis. Thirty-nine patients had acute and 20 patients had chronic gastroduodenitis without ulcer crater. Twelve symptomatic patients had no histologic changes in the gastroduodenal mucosa. Two of the ten control subjects had mild gastritis. In the 61% of the patients with classic manifestations of peptic ulcer disease, we could not clinically distinguish the 24 patients with craters, (40% of the classic group) from the 25 patients with acute gastroduodenitis without craters (41% of the classic group). As a result of this study of our group of patients, we believe that gastroduodenitis can be symptomatic and may present with the same manifestations as peptic ulcer crater. Further study will be required to determine whether gastroduodenitis is an independent entity or part of the spectrum of acid peptic (ulcer) disease.


Control Subject Peptic Ulcer Gastritis Dyspepsia Gastrointestinal Symptom 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Schindler R, Ortmayer M, Renshaw JF: Clinical symptoms of chronic gastritis. Arch Intern Med 60:143–153, 1937Google Scholar
  2. 2.
    Carey JB: The symptomatology of gastritis. Am J Dig Dis 5:353–356, 1938Google Scholar
  3. 3.
    Jones CM: Clinical evaluation of gastritis. Am J Dig Dis 8:205–209, 1941Google Scholar
  4. 4.
    Edwards FC, Coghill NF: Clinical manifestations in patients with chronic atrophic gastritis, gastric ulcer and duodenal ulcer. Q J Med 37:337–360, 1968Google Scholar
  5. 5.
    Demling L, Ottenjann R, Elster K: Endoscopy and Biopsy of the Esophagus and Stomach: A Color Atlas (translated by K.H. Soergel). Philadelphia, WB Saunders Co., 1972, pp. 73–74Google Scholar
  6. 6.
    Rhodes J, Evans KT, Lawrie JH, et al: Coarse mucosal folds in the duodenum. Q J Med 37:151–169, 1968Google Scholar
  7. 7.
    Palmer ED: Common duodenitis—of any clinical import? J Am Med Assoc 230:599, 1974Google Scholar
  8. 8.
    Shiner M, Doniach I: A study of x-ray negative dyspepsia with reference to histologic changes in the gastric mucosa. Gastroenterology 32:313–324, 1957Google Scholar
  9. 9.
    Coghill NF: The significance of gastritis. Postgrad Med J 36:733–742, 1960Google Scholar
  10. 10.
    Joske RA, Finkh ES, Wood IJ: Gastric biopsy, a study of 1000 consecutive successful gastric biopsies. Q J Med 24:269–294, 1955Google Scholar
  11. 11.
    Fitzgibbon JH, Long GB: A gastroscopic study of healthy individuals. Gastroenterology 1:67–71, 1943Google Scholar
  12. 12.
    Cotton PB, Price AB, Tighe JR, et al: Preliminary evaluation of “duodenitis” by endoscopy and biopsy. Br Med J 3:430–433, 1973Google Scholar
  13. 13.
    Belber JP: Endoscopic examination of the duodenal bulb: A comparison with x-ray. Gastroenterology 61:55–61, 1971Google Scholar
  14. 14.
    Korn ER, Foroozan P: Endoscopic biopsies of normal duodenal mucosa. Gastrointest Endosc 21:51–54, 1974Google Scholar
  15. 15.
    Beck IT, Kahn DS, Lacerte M, et al: “Chronic duodenitis”: A clinical pathological entity? Gut 6:376–383, 1965Google Scholar
  16. 16.
    Gelzayd EA, Biederman MA, Gelfand DW: Changing concepts of duodenitis. Am J Gastroenterol 64:213–216, 1975Google Scholar
  17. 17.
    Aronson AA, Norfleet RG: The duodenal mucosa in peptic ulcer disease: A clinical pathological correlation. Am J Dig Dis 7:506–514, 1962Google Scholar
  18. 18.
    Shiner M: Duodenal biopsy. Lancet 1:17–19, 1956Google Scholar
  19. 19.
    Ostrow JD, Resnick RH: Hyperchlorhydria, duodenitis and duodenal ulcer: A clinical study of their interrelationships. Ann Intern Med 51:1303–1328, 1959Google Scholar
  20. 20.
    Gear MWL, Truelove SC, Whitehead R: Gastric ulcer and gastritis. Gut 12:639–645, 1971Google Scholar
  21. 21.
    Meikle DD, Taylor KB, Truelove SC, et al: Gastritis, duodenitis and circulating levels of gastrin in duodenal ulcer before and after vagotomy. Gut 17:719–728, 1976Google Scholar
  22. 22.
    Krag E: Enlarged gastric and duodenal rugae. The prognostic significance of the radiological finding of coarse mucosal folds in the stomach and duodenum. Acta Med Scand 179:343–348, 1966Google Scholar
  23. 23.
    Rendich RA: The roentgenographic study of the mucosa in normal and pathologic states. Am J Roentgenol 10:526–537, 1923Google Scholar
  24. 24.
    Ismail-Beigi F, Horton PF, Pope CE: Histological consequences of gastroesophageal reflux in man. Gastroenterology 58:163–174, 1970Google Scholar
  25. 25.
    Behar J, Sheahan DG: Histologic abnormalities in reflux esophagitis. Arch Pathol 99:387–391, 1975Google Scholar
  26. 26.
    Whitehead R: Mucosal biopsy of the gastrointestinal tract.In Major Problems in Pathology, Vol. 3. London, Saunders, 1973Google Scholar
  27. 27.
    Whitehead R, Truelove SC, Gear MWL: The histological diagnosis of chronic gastritis in fiberoptic gastroscope biopsy specimens. J Clin Pathol 25:1–11, 1972Google Scholar
  28. 28.
    Greenlaw R, Sheahan D, DeLuca V et al: Gastroduodenitis—a new concept. Clinicopathological correlations. Gastroenterology 70:891, 1976 (abstract)Google Scholar
  29. 29.
    Whitehead R, Roca M, Meikle DD, et al: The histological classification of duodenitis in fiberoptic biopsy specimens. Digestion 13:129–136, 1975Google Scholar
  30. 30.
    Tominaga K: Distribution of parietal, cells in the antral mucosa of human stomachs. Gastroenterology 69:1201–1207, 1975Google Scholar
  31. 31.
    Taylor AL: The epithelial heterotopias of alimentary tract. J Pathol Bacteriol 30:415–449, 1927Google Scholar
  32. 32.
    Katon RM, Smith FW: Panendoscopy in the early diagnosis of acute upper gastrointestinal bleeding, Gastroenterology 66:728–734, 1973Google Scholar
  33. 33.
    DeLuca V, Sheahan DG: The esophagus in patients with gastroduodenitis and peptic ulcer disease. South Med J 71 (Suppl 1):52, 1978Google Scholar
  34. 34.
    Schindler R, Murphy HM: Symptomatology of chronic atrophic gastritis. Am J Dig Dis 7:7–13, 1940Google Scholar
  35. 35.
    Heinkel K: In General Discussion, Panel Discussion, chronic gastritis,In 2nd World Congress of Gastroenterology, Munchen, 1962, Vol. 2, Schmid E, Tomenius J, Watkinson G (eds.) Basel, S. Karger, 1963, pp 150–153 (109–261)Google Scholar
  36. 36.
    Spiro HM: Visceral viewpoints: Moynihan's disease? The diagnosis of duodenal ulcer N Engl J Med 291:567–569, 1974Google Scholar
  37. 37.
    DeLuca V, Spiro HM: Gastric mucosa in acute duodenal ulcer. Arch Intern Med 111:363–366, 1963Google Scholar
  38. 38.
    Czaja AJ, McAlhany JC, Pruitt BA, Jr Acute duodenitis and duodenal ulceration after burns. Clinical and pathological characteristics. J Am Med Assoc 232:621–624, 1975Google Scholar
  39. 39.
    Krag E: Pseudoulcer and true peptic ulcer. A clinical, radiographic and statistical followup study. Acta Med Scand 178:713–728, 1965Google Scholar
  40. 40.
    Wellbrock WLA: Duodenitis and duodenal ulcer. Ann Surg 91:533–539, 1930Google Scholar
  41. 41.
    Cheli R: Duodenitis and duodenal ulcer. A biopsy study. Digestion 1:175–182, 1968Google Scholar
  42. 42.
    Sprinz H: Pathogenesis of intestinal infections. Arch Pathol 87: 556–562, 1969Google Scholar
  43. 43.
    Gillies MA, Skyring A: Gastric and duodenal ulcer. The association between aspirin ingestion, smoking and family history of ulcer. Med J Aust 2:280–285, 1969Google Scholar
  44. 44.
    Doll R, Jones FA, Pygott F: Effect of smoking on the production and maintenance of gastric and duodenal ulcers. Lancet 1:657–662, 1958Google Scholar
  45. 45.
    Peterson WL, Sturdevant RAL, Frankl HD, et al: Healing of duodenal ulcer with an antacid regimen. N Engl J Med 297:341–345, 1977Google Scholar
  46. 46.
    Mollmann KM, Bonnevie O, Gudman-Hoyer E, et al: A diagnostic study of patients with upper abdominal pain. Scand J Gastroenterol 10:805–809, 1975Google Scholar

Copyright information

© Digestive Disease Systems, Inc. 1980

Authors and Affiliations

  • R. Greenlaw
    • 1
    • 2
    • 3
    • 4
  • D. G. Sheahan
    • 1
    • 2
    • 3
    • 4
  • V. DeLuca
    • 1
    • 2
    • 3
    • 4
  • D. Miller
    • 1
    • 2
    • 3
    • 4
  • D. Myerson
    • 1
    • 2
    • 3
    • 4
  • P. Myerson
    • 1
    • 2
    • 3
    • 4
  1. 1.Department of MedicineThe Griffin HospitalDerby
  2. 2.Department of PathologyThe Griffin HospitalDerby
  3. 3.Department of RadiologyThe Griffin HospitalDerby
  4. 4.Yale University School of MedicineNew Haven

Personalised recommendations