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Are gastric and duodenal ulcers separate diseases or do they form a continuum?

  • Controversies in Gastroenterology
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Summary

It is argued that separation of chronic peptic ulcers into gastric and duodenal may be artificial and confuse the search for common factors in their etiology. Differences are often exaggerated by contrasting the extremes of a continuous distribution of ulcers from high gastric lesser curve to duodenal bulb and beyond.

Genetic and epidemiological factors appearing to favor one or the other type of ulcer may act by determining the background cellular changes on which ulcers develop. The extent of the mucosal changes may influence the site of ulceration and incidentally the level of acid secretion. Thus ulcers could be driven distally or drawn proximally across the arbitrary boundary of the pylorus.

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References

  1. Jones FA, Gummer JWP, Lennard-Jones JE: Clinical Gastroenterology, 2nd ed. Oxford, Blackwell, 1968, p 469

    Google Scholar 

  2. Hurst AF, Stewart MJ: Gastric and Duodenal Ulcer. Oxford, Oxford University Press, 1929, pp 99–102

    Google Scholar 

  3. Portis SA, Jaffe RH: Study of peptic ulcer based on necropsy records. J Am Med Assoc 110:6–13, 1938

    Google Scholar 

  4. Stout AP: Tumors of stomach. Bull NY Acad Med 23:101–108, 1947

    Google Scholar 

  5. Okabayashi A: Pathological findings of gastric ulcer. Saishin Igaku 8:169, 1953

    Google Scholar 

  6. Taniguchi T: Surgical management of gastric and duodenal ulcer in Japan. J Int Coll Surg 27:411–418, 1957

    Google Scholar 

  7. Oi M, Oshida K, Sugimura S: The location of gastric ulcer. Gastroenterology 36:45–56, 1959

    Google Scholar 

  8. Oi M, Sakurai Y: The location of duodenal ulcer. Gastroenterology 36:60–64, 1959

    Google Scholar 

  9. Oi M, Ito Y, Kumagai F, Yoshida K, Tanaka Y, Yoshikawa K, Miho O, Kijima M: A possible dual control mechanism in the origin of peptic ulcer. Gastroenterology 57:280–293, 1969

    Google Scholar 

  10. Thomas J, Greig M, McIntosh J, Hunt J, McNeil D, Piper DW: The location of chronic gastric ulcer. A study of the relevance of ulcer size, age, sex, alcohol, analgesic intake and smoking. Digestion 20:79–84, 1980

    Google Scholar 

  11. Ivy AC, Grossman MI, Bachrach WH: Peptic ulcer. New York, Blakiston Co, 1950, pp 506–513

    Google Scholar 

  12. Landboe-Christensen E: The duodenal glands of Brunner in man, their distribution and quantity; an anatomical study. Acta Pathol Microbiol Scand (Suppl) 52:1–267, 1944

    Google Scholar 

  13. Konjetzny GE: Chronische Gastritis und Duodenitis als Ursache des Magensduodenalgeschwürs. Beitr Pathol Anat 71:595–618, 1923

    Google Scholar 

  14. Magnus HA: Gastritis.In Modern Trends in Gastroenterology, FA Jones ed. London, Butterworths, 1952, pp 346–351

    Google Scholar 

  15. Du Plessis DJ: Pathogenesis of gastric ulceration. Lancet 1:974–978, 1965

    Google Scholar 

  16. Gear MWL, Truelove SC, Whitehead R: Gastric ulcer and gastritis. Gut 12:639–645, 1971

    Google Scholar 

  17. Rubin W: Intestine in the stomach. Transformation of the gastric mucosa into an absorptive tissue. Gastroenterology 54:116–118, 1968

    Google Scholar 

  18. Kreuning J, Bosman FT, Kuiper G, Lindeman J: Gastric and duodenal mucosa in ‘healthy’ individuals: An endoscopic and histopathological study of 50 volunteers. J Clin Pathol 31:69–77, 1978

    Google Scholar 

  19. James AH: Gastric epithelium in the duodenum. Gut 5:285–294, 1964

    Google Scholar 

  20. Hoedemaeker PJ: Heterotopic gastric mucosa in the duodenum. Digestion 3:165–173, 1970

    Google Scholar 

  21. Johansen A, Hart Hansen O: Heterotopic gastric epithelium in the duodenum and its correlation to gastric disease and acid level. Acta Pathol Microbiol Scand Section A 81(5):676–680, 1973

    Google Scholar 

  22. Kirk RM: The contribution of wound contraction to the healing of peptic ulcers.In Digestive Surgery. Padova Italy, Piccin, 1974, pp 57–58

    Google Scholar 

  23. Capper WM: Factors in the pathogenesis of gastric ulcer. Ann R Coll Surg Eng 40:21–35, 1967

    Google Scholar 

  24. Ruding R: Gastric ulcer and antral border. Surgery 61:495–497, 1967

    Google Scholar 

  25. Trier JS: Morphology of the gastric mucosa in patients with ulcer diseases. Am J Dig Dis 21:138–140, 1976

    Google Scholar 

  26. Marks IN, Shay H: Observations on the pathogenesis of gastric ulcer. Lancet 1:1107–1111, 1959

    Google Scholar 

  27. Schrager J, Spink R, Mitra S: The antrum in patients with duodenal and gastric ulcers. Gut 8:497–508, 1967

    Google Scholar 

  28. Stemmerman G, Haenszel W, Locke F: Epidemiologic pathology of gastric ulcer and gastric carcinoma among Japanese in Hawaii. J Natl Cancer Inst 58:13–19, 1977

    Google Scholar 

  29. Cox AJ: Stomach size and its relation to chronic peptic ulcer. Arch Pathol 54:407–422, 1952

    Google Scholar 

  30. Bock OAA, Richards WCD, Witts LJ: The relationship between acid secretion after augmented histamine stimulation and the histology of the gastric mucosa. Gut 4:112–114, 1963

    Google Scholar 

  31. Card WI, Marks IN: The relationship between the acid output of the stomach following ‘maximal’ histamine stimulation and the parietal cell mass. Clin Sci 19:147–163, 1960

    Google Scholar 

  32. Baron JH: An assessment of the augmented histamine test in the diagnosis of peptic ulcer. Gut 4:243–253, 1963

    Google Scholar 

  33. Meeroff JC: Secretory gradient of acid in peptic ulcer. Gastroenterology 64:508, 1973

    Google Scholar 

  34. Reslinski B: Gastric juice acidity and the site of peptic ulcers. Pol Przegl Chir 47:477–480, 1975

    Google Scholar 

  35. Fiddian-Green RG, Bank S, Marks IN, Louw JH: Maximum acid output and position of peptic ulcers. Lancet 2:1370–1373, 1976

    Google Scholar 

  36. Bittner R, Beger HG, Bittner L, Steinert W, Meves M: The relationship between peptic ulcer localization and gastric acid secretion, gastric emptying and gastrin secretion. Br J Surg 66:875, 1979

    Google Scholar 

  37. Schade RO: Non-ulcer dyspepsia and gastric cytology; a preliminary report. Schweiz Z Allg Pathol Bakteriol 21:608–613, 1958

    Google Scholar 

  38. Ball PAJ, James AH: The histological background to gastric ulcer. Lancet 1:1365–1367, 1961

    Google Scholar 

  39. Meikle DD, Taylor KB, Truelove SC, Whitehead R: Gastritis, duodenitis and circulating levels of gastrin in duodenal ulcer before and after vagotomy. Gut 17:719–728, 1976

    Google Scholar 

  40. Konjetzny GE: Zur Pathologie und Chirurgischen behandling des Ulcus duodeni. D Z Chir 184:85–104, 1924

    Google Scholar 

  41. McCarty WC: Excised duodenal ulcers. A report of four hundred and twenty five specimens. J Am Med Assoc 83:1894–1898, 1924

    Google Scholar 

  42. Kreuning J: Chronic Non-Specific Duodenitis. Delft, WD Meinema, 1979

    Google Scholar 

  43. Cheli R: Duodenitis and duodenal ulcer. Digestion 1:175–182, 1968

    Google Scholar 

  44. Myagkova LP, Gorodinskaya VS, Sokolova GN: The effect of duodenitis on healing of chronic ulcer in the duodenum. Arkh Patol 37:50–54, 1975

    Google Scholar 

  45. Thomson WO, Robertson AG, Imrie CW, Joffe SN, Lee FD, Blumgart LH: Is duodenitis a dyspeptic myth? Lancet 1:1197–1198, 1977

    Google Scholar 

  46. Pillay CV, Moshal MG, Bryer JV, Booyens J: Ultrastructure of duodenal epithelial cells in patients with active duodenal ulcers and after treatment with cimetidine. S Afr Med J 52:1082–1085, 1977

    Google Scholar 

  47. Wormsley KG, Grossman MI: Maximal histolog test in control subjects and patients with peptic ulcer. Gut 6:427–435, 1965

    Google Scholar 

  48. Gilmour J: The surgical aspects of gastritis and its role in gastric pathology. Br J Surg 49:278–288, 1961

    Google Scholar 

  49. Nwokolo CW: Gastric ulceration in southern Nigeria. W Afr Med J 5:210–213, 1966

    Google Scholar 

  50. Tovey FL, Tunstall M: Duodenal ulcer in black populations in Africa south of the Sahara. Gut 16:564–576, 1975

    Google Scholar 

  51. Dogra JR: Studies on peptic ulcer in south India. Part IV. Incidence of peptic ulcer in India with particular reference to South India. Indian J Med Res 29:665–676, 1941

    Google Scholar 

  52. Malhotra SL: Peptic ulcer in India and its aetiology. Gut 5:412–416, 1964

    Google Scholar 

  53. Tovey FI: Duodenal ulcer in Mysore. Characteristics and aetiological factors. Trop Geogr Med 24:107–117, 1972

    Google Scholar 

  54. Lancet: Why does peptic ulcer happen? Lancet 1:1074–1075, 1975 (leader)

    Google Scholar 

  55. Yamagata S: Epidemiology of ulcer in Japan.In Proceedings, Second World Congress of Gastroenterology, Vol 11, S Karger, Basel, 1963, p 285

    Google Scholar 

  56. Menguy R: Pathophysiology of peptic ulcer. Am J Surg 120:282–288, 1970

    Google Scholar 

  57. Garrido-Klinge G, Pena L: Gastroduodenal ulcer in high altitudes (Peruvian Andes). Gastroenterology 37:390–400, 1959

    Google Scholar 

  58. Schanke K: Behaviour of ulcer in fishing district in north of Norway: Studies on frequency and localization. Acta Chir Scand 94 (Suppl 115):1–203, 1946

    Google Scholar 

  59. British Medical Journal: Sex differences in duodenal ulcer. Br Med J 1:641–642, 1979 (leader)

    Google Scholar 

  60. Langman M: The changing nature of the duodenal ulcer diathesis.In Chronic Duodenal Ulcer. C Wastell (ed). London, Butterworth, 1974, pp 3–9

    Google Scholar 

  61. Susser M, Stein Z: Civilization and peptic ulcer. Lancet 1:115–119, 1962

    Google Scholar 

  62. Mendeloff AI: What has been happening to duodenal ulcer? Gastroenterology 67:1020–1022, 1974

    Google Scholar 

  63. Elashoff JD, Grossman MI: Trends in hospital admissions and death rates for peptic ulcer in the United States from 1970 to 1978. Gastroenterology 78:280–285, 1980

    Google Scholar 

  64. Doll R, Buch J: Hereditary factors in peptic ulcer. Ann Eugen 16:135–146, 1951

    Google Scholar 

  65. Doll R, Kellock TD: The separate inheritance of gastric and duodenal ulcers. Ann Eugen 16:231–240, 1951

    Google Scholar 

  66. Evans DAP: Genetic factors in the etiology of duodenal ulcer. Gastroenterology 40:371–378, 1961

    Google Scholar 

  67. Baron JH: Gastric secretion in relation to subsequent duodenal ulcer and family history. Gut 3:158–161, 1962

    Google Scholar 

  68. Jensen KG: Peptic Ulcer—Genetic and Epidemiological Aspects Based on Twin Studies. Copenhagen, Munksgaard, 1972

    Google Scholar 

  69. Clarke CA, Evans DAP, McConnell RB, Sheppard PM: Secretion of blood groups and peptic ulcer. Br Med J 1:603–607, 1959

    Google Scholar 

  70. Gough MJ, Giles GR: HLA Antigens in duodenal ulceration. Gut 20:A919, 1979

    Google Scholar 

  71. Rotter JI, Rimoin DL, Gursky JM, Terasaki P, Sturdevant RAL: HLA-B5 associated with duodenal ulcer. Gastroenterology 73:438–440, 1977

    Google Scholar 

  72. O'Brien BD, Thomson ABR, Dossetor JB: HLA and peptic ulcer. Am J Dig Dis 24:314–315, 1979

    Google Scholar 

  73. Rotter JI, Sones JQ, Samloff IM, Gursky JG, Richardson CT, Walsh JH, Rimoin DL: Duodenal ulcer disease associated with elevated serum pepsinogen I. N Engl J Med 300:63–66, 1979

    Google Scholar 

  74. Rotter JI, Rimoin DL: Peptic ulcer disease—a heterogenous group of disorders? Gastroenterology 73:604–607, 1977

    Google Scholar 

  75. Rotter JI, Rimoin DL, Samloff IM: Genetic heterogeneity in peptic ulcer. Lancet 1:1088–1089, 1979

    Google Scholar 

  76. British Medical Journal: Genetics of duodenal ulcer. Br Med J 3:557–558, 1975 (leader)

    Google Scholar 

  77. Dobernick RC, Engle JC: Quantitative evaluation of the gastric mucosa of normal subjects and subjects with various gastric disorders. Surgery 59:189–194, 1966

    Google Scholar 

  78. Samloff IM, Secrist DM, Passaro EP Jr: A study of the relationship between serum group I pepsinogen levels and gastric acid secretion. Gastroenterology 69:1196–1200, 1975

    Google Scholar 

  79. Johnson LR: The trophic action of gastrointestinal hormones. Gastroenterology 70:278–288, 1976

    Google Scholar 

  80. Paterson DE, Hancock DM: The exact site and extent of duodenal ulceration. Br J Radiol 33:43–51, 1960

    Google Scholar 

  81. Hollander F: Are gastric ulcer and duodenal ulcer different diseases? Surg Clin North Am 27:265–271, 1947

    Google Scholar 

  82. Shay H, Lorber SH: Are gastric and duodenal ulcer diseases the same entities?In Peptic Ulcer. DJ Sandweiss (ed) Philadelphia, WB Saunders, 1951, pp 175–184

    Google Scholar 

  83. Schwarz K: Ueber penetrierende Magen-und Jejunal-geschwüre. Beitr 2 Klin Chir 67:96–128, 1910

    Google Scholar 

  84. Duberstein DL, Efrusy ME: Benign gastric ulceration with pentagastrin-fast achlorhydria (the first reported case). Gastroenterology 72:1369–1370, 1977

    Google Scholar 

  85. Kirk RM: Can the singularity of peptic ulcers be described by catastrophe theory and explained by biofeedback? Gastroenterology 73:608–610, 1977

    Google Scholar 

  86. Wilkie DPD: Coincident duodenal and gastric ulcer. Br Med J 2:469–470, 1926

    Google Scholar 

  87. Weisberg H, Glass GJB: Coexisting gastric and duodenal ulcers: A Review. Am J Dig Dis 8:992–1007, 1963

    Google Scholar 

  88. Watkinson G: The incidence of chronic peptic ulcer found at necropsy. A study of 20,000 examinations performed in Leeds in 1930–49, and in England and Scotland in 1956. Gut 1:14–30, 1960

    Google Scholar 

  89. Bonnevie O: The incidence in Copenhagen County of gastric and duodenal ulcers in the same patient. Scand J Gastroenterol 10:529–536, 1975

    Google Scholar 

  90. Doll R, Avery Jones F, Pygott F: Effect of smoking on the production and maintenance of gastric and duodenal ulcer. Lancet 1:657–662, 1958

    Google Scholar 

  91. Peterson WL, Sturdevant RAL, Frankl HD, Richardson CT, Isenberg JI, Elashoff JD, Sones JQ, Gross RA, McCallum RW, Fordtran JS: Healing of duodenal ulcer with an antacid regime. N Engl J Med 297:341–345, 1977

    Google Scholar 

  92. Doll R, Jones PA, Pygott F, Stubbe SL: The risk of gastric cancer after medical treatment for gastric ulcer. Gastroenterologia 88:1–12, 1957

    Google Scholar 

  93. Larson NE, Cain JC, Bartholomew LG: Prognosis of medically treated small gastric ulcers: II. Ten year to nineteen-year follow-up study of 391 patients. N Engl J Med 264:330–334, 1961

    Google Scholar 

  94. Duthie HL: Vagotomy for gastric ulcer. Gut 11:540–545, 1970

    Google Scholar 

  95. British Medical Journal: Gastritis and gastric cancer. Br Med J 1:309, 1972

    Google Scholar 

  96. Butler ML, Gersh H: Antacids vs placebo in hospitalized gastric ulcer patients: a controlled therapeutic study. Am J Dig Dis 20:803–807, 1975

    Google Scholar 

  97. Doll R: Medical treatment of gastric ulcer. Scot Med J 9:183–196, 1964

    Google Scholar 

  98. Doll R, Hill ID, Hutton C, Underwood DJ: Clinical trial of a triterpenoid liquorice compound in gastric and duodenal ulcer. Lancet 2:793–796, 1962

    Google Scholar 

  99. Sahel J et al: Carbenoxolene sodium capsules in the treatment of duodenal ulcer. An endoscopic controlled trial. Gut 18:717–720, 1977

    Google Scholar 

  100. Winship DH: Cimetidine in the treatment of duodenal ulcer. Gastroenterology 74:402–406, 1978

    Google Scholar 

  101. Freston JW: Cimetidine in the treatment of gastric ulcer. Gastroenterology 74:426–430, 1978

    Google Scholar 

  102. Goligher JC, DeDombal FT, Conyers JH, Duthie HL, Feather DB, Latchmore AJC, Shoesmith JH, Smiddy FG, Wilson-Pepper J: Five to eight-year results of Leeds/York controlled trial of elective surgery for duodenal ulcer. Br Med J 2:781–787, 1968

    Google Scholar 

  103. Duthie HL, Bransom CJ: Highly selective vagotomy with excision of the ulcer compared with gastrectomy for gastric ulcer in a randomized trial. Br J Surg 66:43–45, 1979

    Google Scholar 

  104. Johnson HD: The classification and principles of treatment of gastric ulcer. Lancet 2:510–514, 1957

    Google Scholar 

  105. Holst-Christensen J, Hart Hansen O, Pedersen T, Kronborg O: Recurrent ulcer after proximal gastric vagotomy for duodenal and pre-pyloric ulcer. Br J Surg 64:42–46, 1977

    Google Scholar 

  106. Niwayama G, Terplan K: A study of peptic ulcer based on necropsy records. Gastroenterology 36:409–422, 1959

    Google Scholar 

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  1. Department of Surgery, Royal Free Hospital, NW3 2QG, London, England

    R. M. Kirk MS, FRCS

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Kirk, R.M. Are gastric and duodenal ulcers separate diseases or do they form a continuum?. Digest Dis Sci 26, 149–154 (1981). https://doi.org/10.1007/BF01312235

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