A Roentgenographic Study of the Relative Incidence of Gastric and Duodenal Ulcer

Abstract

There is a rather marked discrepancy in published statistics on the relative incidence of duodenal and gastric ulcer. To some extent this may be explained by the different methods of study used, some figures being derived solely from autopsied cases, others being based on operative findings, and still others on clinical observations, with or without roentgenographic examination. Gastric ulcers were formerly believed to be more numerous than duodenal ulcers but today almost all statistics reverse the incidence. The divergence has frequently been explained as being due to faulty clinical diagnosis or to inadequate autopsy technic. Until the advent of x-ray, postmortem examinations were the chief source of information. Even in the recent literature wide differences are found between the observations of the pathologist and those of the clinician or roentgenologist. In 1938 Portis and Jaffé (8) in a series of 9,171 consecutive autopsies found 455 peptic ulcers, 240 of which were gastric and 215 duodenal. Similarly Stewart (10) found among 1,500 autopsies 130 cases of peptic ulcer equally distributed between those of the stomach and those of the duodenum. Unlike the pathologist, the surgeon and roentgenologist see a greater proportion of duodenal ulcers than gastric ulcers. Thus Mayo (5) reported that at the Mayo Clinic 1,191 patients had been found at operation to have gastric ulcer and 4,532 patients duodenal ulcer, a proportion of 1:4. This may be explained in part by the fact that duodenal ulcers are more likely to produce symptoms severe enough to cause the patient to seek medical or surgical relief than are gastric ulcers with their more silent clinical course. In addition, duodenal lesions tend to be chronic and to occur where the lumen of the gastrointestinal tract is relatively small. Consequently there is greater tendency to obstruction due to spasm or scar formation. The study here recorded is based on 4,400 consecutive gastro-intestinal examinations made during the period 19261939 at the Colorado General Hospital. Only cases in which the radiologic study confirmed the clinical diagnosis are considered. A total of 883 gastric and duodenal ulcerations were seen, an incidence of slightly more than 20 per cent of the cases examined. Eusterman (2) reports ulcer of the duodenum in 12.2 per cent and gastric ulcer in 1per cent of a series of 15,985 cases examined by x-ray. Gorman (3) studied radiographically 534 cases and reported duodenal ulcer in 9 per cent and gastric ulcer in 1 per cent. Percy and Beilin (7) in 1,000 examinations found 17.1 per cent duodenal and 2.1 per cent gastric ulcers. Of our 883 cases of peptic ulcer, 689, or 78 per cent, were duodenal, and 194, or 22 per cent, were gastric. Figures in the literature show a wide variation from these percentages. Baetjer and Friedenwald (1) in their study of 743 cases reported 43 per cent duodenal, 40 per cent gastric, and 14 per cent pyloroduodenal ulceration.