Write about Duodenal Ulcers here.

• 4 x commoner than gastric ulcers

• Major Risk Factors:

• H. pylori (90%)

• drugs (aspirin, NSAIDs, steroids)

• Minor Risk Factors:

• Increased gastric acid secretion

• Increased gastric emptying (reduced duodenal pH)

• Blood group O

• Smoking

• Role of stress = controversial

• Symptoms:

• Epigastric pain typically before meals or at night, relieved by eating, or drinking milk

• 50% are asymptomatic, others experience recurrent episodes

• Signs:

• Epigastric tenderness (non-specific)

• Diagnosis:

• Upper GI endoscopy (stop anti-ulcer drugs 1/52 before)

• Test for H. pylori

• Gastrin concentrations should be measured if Zollinger-Ellison syndrome is suspected

• Differential:

• Non-ulcer dyspepsia

• Duodenal Crohn's Disease

• TB

• Lymphoma

• Pancreatic cancer

Treatment of Peptic Ulcers