Duodenal Pathology Research Articles

A comparative study of double contrast and single contrast barium meals with endoscopic arbitration in the diagnosis of peptic ulcer

The study compares the ability of a simple double contrast technique with our standard single contrast barium meal to diagnose peptic ulceration. Two hundred and six patients were randomly allocated to either examination. Endoscopy was used as the definitive diagnostic procedure. Deformity of the duodenal cap was more accurately detected by the double contrast technique (P less than 0.01). There was no significant difference in the detection rates for duodenal ulcer. False positive or false negative diagnoses of duodenal pathology were similar by both techniques. The incidence of gastric ulceration in the series was too low for statistical analysis.

Endoscopic Examination of the Duodenal Bulb: A Comparison With X-Ray

In 200 consecutive upper gastrointestinal endoscopic examinations in patients having a concomitant upper gastrointestinal X-ray study, the duodenum was entered in 183. In 144 cases endoscopic and X-ray diagnosis of duodenal bulb pathology agreed; in 37, the diagnosis was made only by endoscopy; and in 19, by X-ray alone. Of 59 patients with duodenal ulcers, endoscopy diagnosed 55 and X-ray, 42. A total of 70 ulcers were identified in the 59 patients, 66 (94%) by endoscopy and 45 (65%) by X-ray. Associated duodenal deformity made X-ray interpretation difficult. Duodenitis was commonly encountered endoscopically, producing symptoms in some patients in the absence of frank ulceration. In order to determine the full extent of upper gastrointestinal pathology, esophagus, stomach, and proximal duodenum were examined with a forward-viewing endoscope in all cases. A lateral-viewing endoscope was used for supplementation in 50 cases, and furnished additional information on 18 duodenal bulbs.

"Tubeless" hypotonic duodenography: technique, value and limitations.

"TUBELESS" HYPOTONIC DUODENOGRAPHY: TECHNIQUE, VALUE AND LIMITATIONSWILLIAM MARTEL, M.D., PAUL A. SCHOLTENS, M.D. and LILY W. LIM, M.D.Audio Available | Share

Evidence for the release of gastric fibrinolytic activity into peripheral blood.

Ourprevious paper(Cox,Poller, andThomson, 1967) suggested thatlocal gastric fibrinolysis may play apartincausing acute gastric bleeding without anobvious ulcer andperhaps also incausing chronic peptic ulceration. Asaconsequence ofthese results theneedtoinvestigate clinical cases ofbleeding gastric ulcer forabnormal fibrinolysis hasbeen suggested (Lancet, 1967). Itappeared preferable atthis juncture, however, tostudy theproblem ofgastric fibrinolysis inmore general termsbecause investigation ofcaseswith gastric bleeding issubject toanumber ofdifficulties: sudden bloodloss byitself mayproduce shockand hencefibrinolytic activity; fibrinolytic enzymes are notoriously labile; andthetimerelationship to bleeding maybeuncertain. Itwasduring consequent investigations ofgastric fibrinolysis that wefoundthatdigital compression ofthestomach atlaparotomy produced markedly raised fibrinolytic activity inperipheral venous blood. Inthis paper wedescribe these findings and their possible clinical implications. METHOD OFSTUDY Previously thegastric veinspecimens weretaken before anymanipulation ofthestomach. Thestomach, however, isnota quiescent static organ. Pressures rise during peristalsis andvomiting. Inthepresent study, before taking gastric veinspecimens, weapplied digital pressure tothestomach walls inanattempt toreproduce onthem theeffect ofnaturally occurring rises inpressure. In addition we carried outserial studies on peripheral venous blood toseewhether thestomach canbeasource ofperipheral venousfibrinolytic activity. Thestudy wasperformed on18patients whounderwent laparotomy. Twelve hadchronic duodenal ulcers, two withassociated pyloric obstruction; fourpatients had gallstones withno evidence ofgastric or duodenal pathology; twopatients weresuspected ofhaving a chronic duodenal ulcer because ofradiological findings andclinical history, butnopathology intheduodenum, stomach, orgallbladder wasseenatoperation. The gallstones wereremovedbycholecystectomy; ofthe

Achlorhydria and Duodenal Ulcer: A Report of Two Cases Having Achlorhydria and Diagnosed as Duodenal Ulcer not Proven at Surgery

Summary 1. Two cases in which there was x-ray evidence of active duodenal ulcer and laboratory evidence of persistent achlorhydria have been presented. Both were found at operation to have chronic cholecystitis with no evidence of intrinsic duodenal pathology. 2. From the analysis of these two cases it may be suggested that cases reported as duodenal ulcer confirmed by x-ray and presenting a persistent achlorhydria to histamine testing should not be considered as proven ulcer but other pathologic states should be sought. 3. Some of the more important pathologic states causing duodenal deformity other than peptic ulcer have been mentioned. 4. A diagnosis of peptic ulcer is incompatible in the presence of a true achlorhydria.

Duodenal Ulcer in the Presence of a Gall-Bladder Symptomatology

IN its typical form, peptic ulcer gives a symptom complex which runs more true to form than is the case in almost any other condition. The characteristics for peptic ulcer in general may be roughly divided into four as follows: First, meal relation; second, food ease; third, intermittance, and fourth, chronicity. There is a variation in the symptomatology, particularly as regards food ease, between ulcers in the prepyloric region and those in the postpyloric region. Moynihan (1) has aptly illustrated this in the sequence of pain in relationship to food, in the following manner: “In cases of gastric ulcer, the pain which, after an interval, follows the taking of a meal, gradually disappears before the next meal. In cases of duodenal ulcer, the pain continues until the next meal, or until food is taken to give ease to a wearisome pain. The rhythm of gastric ulcer is ‘food, comfort, pain, comfort’: of duodenal ulcer it is ‘food, comfort, pain’: a quadruple rhythm in the former disease, a triple rhythm in the latter.” Following the ingestion of food, pain is liable to occur at an earlier time in gastric ulcer than in duodenal ulcer. A characteristic which is frequently noted is the occurrence of night pain, which may come on at the same hour every night. The type of food ingested may cause greater or less pain, the aromatic vegetables and heavy meats producing the most severe type of pain. In duodenal ulcer, particularly, although these same foods may give relief more rapidly, pain tends to return in a more severe form. In both gastric and duodenal ulceration, a certain number of individuals will give a history which is in no way typical of either condition. In going over a group of cases operated upon at St. Luke's Hospital, New York City, for gall-bladder disease, I was interested in the number in which either mild or moderately severe cholecystitis was noted, with adhesions to the duodenum and the presence of single or multiple ulcers in the adherent area. The interesting question that arises is, which came first, the cholecystitis or the duodenal pathology? Among many theories as to the cause of peptic ulcer (Nelson, 2), there is mentioned an anatomic relationship between the gall bladder, appendix, and the stomach and duodenum through the related vascular supply of the omentum. The causes of peptic ulcer are generally considered to be thermal, chemical, bacterial, or nervous. Whatever the etiologic factors may be, it is generally accepted that the final stages are (a) lowering the resistance of the intestinal mucosa, possibly by altering the production of their protective secretions, and (b) allowing digestion of the mucosa by the acid pepsin formed in its own glands.

Acute dilatation of stomach with report of a case

The common causes of the syndrome of acute dilatation of the stomach have been reviewed and its physiology briefly discussed. A case of acute dilatation of the stomach has been presented which appeared to have a combined pancreatic and duodenal pathology as its main etiology

The Niche as the Roentgen Sign of Duodenal Ulcer with a Report of 42 Cases

THE duodenal defect has been recognized, since Cole mentioned it, as the characteristic roentgen sign of duodenal ulcer. His studies, based on the direct evidence of duodenal pathology, helped materially to enhance the diagnosis of duodenal ulcer and proved the validity of the direct method of roentgen diagnosis. The indirect method is dependent solely upon functional disturbances and cannot supply more than presumptive evidence. Only end-results, such as gastrectasia, with all its concomitant manifestations of pyloric stenosis, can be regarded as immutable evidence of an organic lesion. The early signs of hyperperistalsis, hypertonicity and hypermotility are purely functional in character and are dependent upon the increased irritability of the autonomic nervous system. They are common to many conditions and may occur in simple vagotonia, as well as in all reflex gastric disturbances arising from intra- or extra-abdominal causes. These indirect signs may be readily compared to the clinical symptom group of pyrosis, belching, water-brash, etc., which are common to so many functional and organic conditions. They have no significance in themselves unless correlated with a definite clinical entity. Roentgenologicaly as well as clinically, the indirect signs merely help to draw attention to an existing lesion, without particularly specifying its character or location. Cole's method, therefore, made the diagnosis of post-pyloric or duodenal ulcers possible in a larger percentage of cases. He established for the duodenum what Haudek had previously done for the stomach, i. e., a method of diagnosis dependent upon the direct visualization of the lesion. The morphological differences in the roentgen appearance between a duodenal and gastric ulcer, representing a filling defect in one and a pouching or niche in the other, were not clearly understood for some time. Cole attributed the filling defect on the duodenal contour to organic changes, such as induration of the ulcer or a cicatricial contraction in the walls of the duodenum. Carman later drew attention to functional spastic phenomena in the wall of the duodenum in the segment of the ulcer, which also produced filling defects. Akerlund's (1,2) recent studies, however, on the mechanics of the duodenum, and his ability to compare a large series of operative cases with the roentgen findings, aided materially in the elucidation of duodenal deformities and in the roentgen interpretation of duodenal ulcers. He found that the deformities occurring in duodenal ulcers were always due to a combination of organic and functional causes, and that the most constant manifestation of these ulcers was a niche, which was present in 60 per cent of his series. The functional deformities accompanying the niche were analogous somewhat to the gastric incisures occurring in the plane of the ulcer, these always disappearing under anesthesia.