Acute perforated duodenal ulcer is not associated with Helicobacter pylori infection.

Most patients with chronic duodenal ulcer disease have Helicobacter pylori infection and eradicating it considerably reduces the relapse rate. The prevalence of H pylori in 80 patients (mean age = 52 years, range 17-85) presenting with acute perforated duodenal ulcer was examined and compared with age and sex matched hospital control patients. H pylori state was assessed by serum anti-H pylori IgG (Helico-G kit, Porton) using a titre of 18 or less as negative with a specificity of 89% and sensitivity of 88%. Only 47% of the perforated duodenal ulcer patients were positive for H pylori and this was similar to the value of 50% in the controls. In 51 of the perforated duodenal ulcer patients 14C-urea breath tests were also performed 4-10 weeks after surgery and this confirmed that only 49% were positive for H pylori. None of these patients had received perioperative drugs that might have eradicated the infection. The H pylori positive and H pylori negative perforated duodenal ulcer patients were similar with respect to age (53, 51), smoking (84%, 83%), and consumption of more than 15 units of alcohol per week (42%, 38%). Duodenal ulcer disease had been diagnosed before acute perforation in only 24% of those with H pylori and also 24% of those without the infection. Regular non-steroidal anti-inflammatory drug (NSAID) use was common in both those with (44%) and without (45%) H pylori. In conclusion, the lack of association of acute perforated duodenal ulcer and H pylori infection suggests that perforated duodenal ulcer has a different pathogenesis from chronic duodenal ulcer disease, and that the first should not be regarded simply as a complication of the second.     

Retroperitoneal abscess associated with a perforated duodenal ulcer

Retroperitoneal abscess after duodenal ulcer perforation is a rare condition. A 71-year-old woman was admitted with 1 month of appetite loss and back pain. Abdominal computed tomography scan showed a retroperitoneal mass behind the third and fourth portions of the duodenum. Single-balloon enteroscopy revealed erosion of the third portion of the duodenum with leakage of contrast agent into the retroperitoneal space. Based on a preoperative diagnosis of retroperitoneal abscess after duodenal perforation, laparotomy was performed. Partial duodenectomy with a duodeno-jejunal anastomosis was performed, and her postoperative course was uneventful. Pathology showed an ulcer with no specific findings.     

Abnormal small-bowel x-ray patterns associated with active duodenal ulcer

Conclusion 1. The association of unequivocal active peptic ulcer disease with the abnormal small-bowel X-ray pattern commonly known as disordered motor pattern is documented in 37 cases. The association has not been previously reported. These X-ray changes can be severe enough to suggest the presence of intrinsic small-bowel disease.2. Marked improvement of the abnormal small-bowel pattern concurrent with relief of symptoms occurred in 23 of 25 patients examined more than once with a U.S.P. barium mixture.3. Thirteen patients were restudied with nonflocculant barium. The abnormal pattern was corrected in every patient. In seven instances correction was obtained though the patient was still symptomatic.4. Current knowledge relevant to the pathogenesis of this pattern is reviewed and the application of this knowledge to our group of patients is discussed.The authors wish to thank Dr. Michael Bernstein for his help in selection of some of the cases and Dr. John T. Farrar for his editorial criticism.     

Noninfectious ascitic fluid leukocytosis associated with penetrating duodenal ulcer

Summary Ascitic fluid leukocytosis occurring in the cirrhotic patient in the absence of positive peritoneal cultures is often difficult to explain. A unique case of a patient with alcoholic cirrhosis, sterile ascites, and ascitic fluid leukocytosis demonstrated prior to the perforation of a duodenal ulcer has been presented. Based on the patient's clinical course and the pathological events in peptic ulceration of the stomach and duodenum, it is possible to postulate an explanation for the sterile ascitic fluid leukocytosis observed in this patient.     

Electrogastrographic studies in patients with gastric and duodenal ulcer]

The establishment of the motor activity of the gastrointestinal tract is difficult to be performed. The method of electrogastroenterography gives an evidence through an indirect registration of the summation vectors of the action potential. In patients with ventricular ulcer a statistically certain retardation of the changes of the potential/min. in comparison to a control group is to be proved. In patients with duodenal ulcer in the same way a trend is to be observed. It is especially referred to the importance of these examination methods in the sense of examinations of the course of the disease.     

Abnormalities in stomach and duodenal ulcer immunoregulation]

The effect of the immunity state on the clinical course of stomach ulcer was studied. The study involved 50 patients (38 men and 12 women being 17-67 years old) with stomach ulcer (n = 14) and duodenal ulcer (n = 36) in the acute condition and 25 healthy blood donors. Twenty-seven patients underwent an immunology study. It was revealed that the evident increase of circulatory lymphocyte apoptosis (> 10), which is associated with the depression of their proliferative activity in vitro culture, is recorded with 40.7% of patients (11/27). It was also revealed that a high level of circulatory lymphocyte apoptosis and apoptosis-associated dysfunctions are found more frequently in people with long-term and complicated clinical course.     

Aspirin concurrently administered with ranitidine does not delay healing of duodenal ulcer

Sixty-nine patients with endoscopically diagnosed duodenal ulcer were randomised to either Group I or Group II. Group I patients (n= 35) received tablet ranitidine 150 mg twice daily along with tablet aspirin 600 mg three times a day while Group II patients received only tablet ranitidine 150 mg twice daily. Eight patients (four in each group) dropped out of the trial but were included in the final analysis as failure of treatment. At the end of four weeks 51.4% ulcers healed in Group I compared to 58.8% in Group II. The difference between the two groups was not significant. There was also no statistical difference in the time required for relief of pain, number of patients relieved of pain and the complication rate. It is concluded that aspirin concurrently administered with ranitidine is safe and does not delay the healing of uncomplicated duodenal ulcers.