Small bowel (small intestine)
Ulcers
Duodenal peptic ulcer

Author: Hanni Gulwani, M.D. (see Authors page)

Revised: 12 February 2018, last major update August 2012

Copyright: (c) 2003-2018, PathologyOutlines.com, Inc.

PubMed Search: Duodenal peptic ulcer[TIAB] small bowel

Cite this page: Gulwani, H. Duodenal peptic ulcer. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/smallbowelduodenalpepticulcer.html. Accessed April 21st, 2018.
Definition / general
  • Decreasing incidence but still common (Int J Clin Exp Pathol 2012;5:46)
  • Imbalance between gastric acid production and protective factors of intact epithelium and bicarbonate production
  • Increased gastric acid production requires intact fundic mucosa
  • Associated with duodenal Helicobacter pylori and gastric metaplasia
  • Not associated with malignancy
Treatment
  • H2 blockers
  • 80% heal within a month
  • Surgery if hemorrhage, perforation, obstruction or failure to respond to medical treatment
  • Ulcers located posteriorly bleed easily due to pancreaticoduodenal and gastroduodenal arteries in the vicinity
Gross description
  • Usually single lesion within 2 cm of pylorus
  • Multiple lesions throughout duodenum suggest Zollinger-Ellison syndrome
  • Margins well defined
  • No heaped up edges
  • May have large vessel with open lumen at ulcer base
  • Also fibrosis and shortening of duodenum
Microscopic (histologic) description
  • Ulcer usually < 1 cm, circular, small
  • Brown ulcer base (digested blood), no induration of margins of ulcer
  • Abrupt lesions with normal adjacent mucosa
  • No scarring or blood vessel thickening
  • Gastric foveolar cell metaplasia and chronic duodenitis common
  • Various villus abnormalities in proximal duodenum with active duodenitis
  • Also Brunner gland hyperplasia
  • Helicobacter pylori often present
Microscopic (histologic) images

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Additional references