Diagnosis Of Duodenal Ulcer Research Articles

Incidence of Duodenal Ulcer in the Northern Savannah of Nigeria

In 4 years, 200 patients were admitted to the University of Maiduguri Teaching Hospital, in the Northern Savannah of Nigeria, with a clinical diagnosis of peptic ulcer; 60 had the diagnosis of duodenal ulcer confirmed on barium meal or at operation, giving an incidence of 6/1000 adult admissions (excluding obstetrics). There were no gastric ulcers. Forty-four patients had a 'simple ulcer', 10 presented with gastric outlet obstruction, five with peritonitis following perforation and one with haematemesis. There were 44 males, and 16 females, with a mean age of 34 years and mean length of history of 44 months. Contrary to previous published reports improved diagnostic facilities have shown duodenal ulcer to be relatively common in the Northern Savannah of West Africa.

Accuracy of radiologic and endoscopic diagnosis of duodenal ulcer

Accuracy of radiologic and endoscopic diagnosis of duodenal ulcer

Accuracy of Radiologic and Endoscopic Diagnosis of Duodenal Ulcer

On the basis of results of barium examination and upper gastrointestinal endoscopy four diagnostic criteria of duodenal ulcer can be formed: 1) radiography reveals an ulcer, 2) endoscopy reveals an ulcer, 3) both radiography and endoscopy reveal an ulcer, and 4) radiography and/or endoscopy reveals an ulcer. In a consecutive series of 156 patients the accuracy of each of the four diagnostic criteria was determined using the findings of an experienced specialist in upper gastrointestinal endoscopy as a reference. The predictive value of a positive diagnosis (PVpos) for the four diagnostic criteria was 0.63, 0.88, 1, and 0.68, respectively, and the predictive value of a negative diagnosis (PVneg) for all four criteria was around 0.90. The selection of diagnostic criteria should therefore depend on the clinical problem.

The direct method of diagnosis of duodenal ulcer by means of the roentgen ray.

The direct method of diagnosis of duodenal ulcer by means of the roentgen ray.

Accuracy of radiologic and endoscopic diagnosis of duodenal ulcer

On the basis of results of barium examination and upper gastrointestinal endoscopy four diagnostic criteria of duodenal ulcer can be formed: 1) radiography reveals an ulcer, 2) endoscopy reveals an ulcer, 3) both radiography and endoscopy reveal an ulcer, and 4) radiography and/or endoscopy reveals an ulcer. In a consecutive series of 156 patients the accuracy of each of the four diagnostic criteria was determined using the findings of an experienced specialist in upper gastrointestinal endoscopy as a reference. The predictive value of a positive diagnosis (PVpos) for the four diagnostic criteria was 0.63, 0.88, 1, and 0.68, respectively, and the predictive value of a negative diagnosis (PVneg) for all four criteria was around 0.90. The selection of diagnostic criteria should therefore depend on the clinical problem.

Positive predictive value and examiner variability in diagnosing duodenal ulcer.

The positive predictive value of a diagnosis of duodenal ulcer was studied in 255 patients with 274 ulcers diagnosed radiographically. Retrospective analysis of the radiographic examinations and correlation with endoscopy assessed examiner variability, ulcer size, duodenal bulb deformity, and the confidence level of the ulcer diagnoses. For all diagnoses, the overall positive predictive value was 57% with individual predictive values of 47%, 54%, and 70% among three examiners. The individual predictive values correlated directly with the average level of confidence of the diagnoses for each examiner. The sensitivity of the individual examiner for ulcer detection had an inverse relation to the examiner's positive predictive value, confirming that higher sensitivities are achieved at the expense of an increased false-positive rate.

Duodenal ulcer disease in the elderly: a retrospective study.

A retrospective study was performed of 163 patients aged 65 years and over with a diagnosis of duodenal ulceration admitted to one Health District over a period of six years. Eighty per cent of the patients were admitted with acute complications, 50% bled and 30% were perforated. A large proportion of these patients were currently taking anti-inflammatory agents. Patients managed surgically for their complications had a high mortality rate but this was even higher for those managed conservatively. Giant ulcers were found to occur frequently in this age group which had a tendency to severe bleeding. It is concluded that early diagnosis and prompt surgical intervention is essential in the management of complications associated with duodenal ulceration in the elderly.

INNOVATION IN GASTROENTEROLOGICAL MANAGEMENT: THE CASE OF CIMETIDINE

Gastroenterological medicine has, in recent decades, experienced two major innovations, viz. fibre optic endoscopy (a diagnostic technology) and cimetidine, an innovation in ulcer therapy. This paper is concerned with determining the efficacy of cimetidine in reducing the number of surgical procedures for gastric and duodenal ulcer. It is found that, since the introduction of cimetidine, a statistically significant decline in gastric ulcer operations has occurred. A similar result was not obtained for persons with a diagnosis of duodenal ulcer. The picture of substitution of therapies given by this study is in sharp contrast to that depicted in clinical drug trials. This has significance for technology assessment.

A Pragmatic Trial of Cimetidine in Duodenal Ulcer Patients

Fifty-eight outpatients with a clinical and radiological diagnosis of duodenal ulcer completed a double-blind randomized trial of the effect of cimetidine on ulcer symptoms. Patients normally treated in general practice were included in the trial. The patients in the treatment group received cimetidine 1 g daily and the controls received inactive tablets. The treatment period was four weeks. During the last nine days 18 (60%) of 30 cimetidine-treated patients were symptom-free against 5 (18%) of 28 controls (P less than 0.005). The antacid consumption, the number of days with pain and the number of hours with pain also differed significantly in the two groups. Apart from a transient rash in one patient no important clinical side-effects were noted. The serum creatinine rose slightly in the cimetidine-treated patients.

Drug therapy of patients treated in hospitals for duodenal ulcers

Drug therapy in hospitalized patients treated for duodenal ulcer disease was reviewed retrospectively. The information was obtained by the means of a medical audit of patient records indexed by the discharge diagnosis of duodenal ulcers. A total of 485 cases were abstracted. Antacids were found to be the cornerstone of duodenal ulcer drug therapy. Anticholinergic drugs occupied a central role throughout the medical treatment of duodenal ulcers. The investigators identified a need for the dissemination of information concerning the use of anticholinergics in duodenal ulcer patients experiencing the complications of hemorrhage and obstruction.

A Study of Endoscopic Diagnosis of Duodenal Ulcer

A Study of Endoscopic Diagnosis of Duodenal Ulcer

Visceral viewpoints. Moynihan's disease? The diagnosis of duodenal ulcer.

THE clinical diagnosis of duodenal ulcer seems to have been revolutionized by advances in technology, particularly by the development of the fiber-endoscope during the past few years. Yet many questions still need to be asked. In many ways, to consider the clinical diagnosis of duodenal ulcer is to wander in the wiles of epistemology. How do we know? What do we know? Is the matter of duodenal ulcer and its pain simply solipsistic, pain being all that counts, or must we see the ulcer to know that it is there? Is there a different outlook for the patient with duodenal-ulcer . . .

Medical management of peptic ulcer with reference to anti-ulcer agents in other gastro-intestinal diseases.

Patients with chronic peptic ulcer depend upon the doctor of first contact for the initiation of the course of events that could lead to the successful treatment of their disease. The first investigation must be barium meal using an air contrast technique. For the diagnosis of duodenal ulcer, all that is needed is a consistent clinical syndrome and a radiological lesion of the duodenum. Whether this radiological lesion be an actual ulcer crater, spasm or deformity matters not. For the diagnosis of gastric ulcer, not only must a consistent clinical syndrome and radiological lesion be present, but the ulcer must also be demonstrated to be benign. Demonstration of a benign lesion is best done by direct vision gastric biopsy.

DUODENAL ULCER IN CHILDHOOD

There has been some disagreement concerning the admittedly rare incidence of duodenal ulcer disease in children. Because of conflicting reports from other pediatrics centers, we have reviewed the records of all patients admitted to The Children's Hospital of Philadelphia in the past 20 years (1948 through 1967) in whom duodenal ulcer was diagnosed by x-ray, at operation or on postmortem examination (Table I). There were 27 children between the ages of 15 days and 15½ years, with well established duodenal ulcers. Six of these were female (22%). The age at presentation was scattered, but the majority were between 2 and 11 years of age. Presenting complaints were varied: gastrointestinal bleeding was most common in the younger age group, while abdominal pain, usually persistent and intermittent, was the most common symptom in the older children. The diagnosis of duodenal ulcer was made by x-ray examination in 22 patients and at operation in 2; and the ulcers were discovered only at autopsy in 3 children. All the ulcers were duodenal; the precise location was not specified in 9, but 11 were bulbar and 7 were postbulbar. Complications of the ulcer were noted in 9 patients. Perforation occurred in 7 patients, leading to death in 4 (all had disease of the central nervous system) and repeated bleeding in 2. Etiology of the ulcer disease was determined in 15 of the children, but the cause was unknown in 12. Our series is concerned only with duodenal ulcers which, admittedly, comprise the greatest percentage of peptic ulcers.

Silicone Ball Variance: A Clinical and Pulse Duplicator Study

A 49-year-old Caucasian salesman had undergone aortic valve replacement with a Harken caged-ball valve prosthesis in May, 1964, because of aortic stenosis and insufficiency with symptoms of congestive heart failure. There was evidence of mild mitral insufficiency at the time of aortic valve replacement. Convalescence had been rapid and uneventful, and the patient returned to his job. A soft diastolic murmur was present along the left sternal border, and there was a soft systolic murmur at the apex as well. Anticoagulation therapy was discontinued five months after operation because of an episode of upper gastrointestinal bleeding. A diagnosis of duodenal ulcer was established by contrast roentgenography. Sudden chest pain four months later suggested the possibility of coronary artery embolus. Anticoagulation therapy with sodium warfarin was reinstituted. In January, 1967, the patient was awakened by a sudden attack of dyspnea. X-rays had consistently shown cardiac enlargement. Cardiac catheterization revealed a cardiac output of 4.6 liters with an index of 2.4 liters. The left ventricular pressure was 125/0, and the aortic pressure was 125/80. The right ventricular pressure was 50/0, and the pulmonary artery pres-

X-ray diagnosis of duodenal ulcer (II) double contrast method with application of adequate compression

X-ray diagnosis of duodenal ulcer (II) double contrast method with application of adequate compression

DUODENAL ULCER IN CHILDHOOD

There has been some disagreement concerning the admittedly rare incidence of duodenal ulcer disease in children. Because of conflicting reports from other pediatrics centers, we have reviewed the records of all patients admitted to The Children9s Hospital of Philadelphia in the past 20 years (1948 through 1967) in whom duodenal ulcer was diagnosed by x-ray, at operation or on postmortem examination (Table I). There were 27 children between the ages of 15 days and 15½ years, with well established duodenal ulcers. Six of these were female (22%). The age at presentation was scattered, but the majority were between 2 and 11 years of age. Presenting complaints were varied: gastrointestinal bleeding was most common in the younger age group, while abdominal pain, usually persistent and intermittent, was the most common symptom in the older children. The diagnosis of duodenal ulcer was made by x-ray examination in 22 patients and at operation in 2; and the ulcers were discovered only at autopsy in 3 children. All the ulcers were duodenal; the precise location was not specified in 9, but 11 were bulbar and 7 were postbulbar. Complications of the ulcer were noted in 9 patients. Perforation occurred in 7 patients, leading to death in 4 (all had disease of the central nervous system) and repeated bleeding in 2. Etiology of the ulcer disease was determined in 15 of the children, but the cause was unknown in 12. Our series is concerned only with duodenal ulcers which, admittedly, comprise the greatest percentage of peptic ulcers.

Treatment of duodenal ulcer in a small metropolitan community hospital

VAILABLE TODAY for the surgical treatment A of the complications of duodenal ulcer is a spectrum of basic procedures ranging from gastrojejunostomy or modified gastrojejunostomy as recently revived by Poth and Gold [1] to classical gastric resection. It appears increasingly evident that the addition of vagus neurectomy to these standard procedures for duodenal ulcer has lowered the recurrence rate appreciably, and the feasibility and success of pyloroplasty and vagus resection have been established in many centers. Recurrence rates after gastric resection and vagus neurectomy are satisfactory; however, in many series the mortality associated with gastric resection, due principally to difficulties with the duodenal stump, is higher than one should tolerate in the surgical treatment of a benign disease. The present study details the results of the surgical treatment of duodenal ulcer in a small metropolitan community hospital. The surgical staff participating in this study consists of trained surgeons, all either Fellows of the American College of Surgeons, Diplomates of the American Board of Surgery, or qualified by training for the examination of the American Board of Surgery. A retrospective study of the hospital course, mortality, and morbidity of operations for duodenal ulcer is herein presented. From January 1958 to February 1963 gastric resection was employed for the complications of duodenal ulcer in all patients. Since February 1, 1963, all patients with duodenal ulcer treated surgically have been subjected to vagus resection, pyloroplasty with or without plication of the ulcer, and gastrostomy. Fifty-five patients were treated between January 1958 and February 1963 and fifty-two patients from February 1963 to the time of this writing. A comparison will be made of the immediate results of these two operative procedures and the indication for surgical treatment will be listed. In all patients, except some with perforation or massive bleeding, the diagnosis of duodenal ulcer had been confirmed on several occasions by gastrointestinal roentgenographic studies. Gastric acid studies by the twelve hour basal night secretion technic were employed in many patients, and in the remainder a typical histamine gastric analysis was carried out. The two groups were almost identical in composition as related to age, sex, and economic status.

X-ray diagnosis of duodenal ulcer (I) diagnosis by niche

X-ray diagnosis of duodenal ulcer (I) diagnosis by niche

ATYPICAL CLINICAL SYNDROMES OF DUODENAL ULCER.

Observations on 10 less common clinical forms of duodenal ulcer are presented, eight of which include illustrative cases. The dominant feature of these forms is used to designate each type.The physician may avoid pitfalls in the diagnosis of duodenal ulcer by realizing that atypical forms do occur and that an active ulcer may be the cause of almost any type of dyspepsia or upper abdominal distress or backache, and by obtaining an accurate, detailed history during the first interview, keeping these atypical manifestations in mind.