Small intestine & ampulla

Inflammatory disorders

Duodenal peptic ulcer

Topic Completed: 1 August 2012

Minor changes: 18 November 2020

Copyright: 2003-2021,, Inc.

PubMed Search: Duodenal peptic ulcer[TIAB] small bowel

Hanni Gulwani, M.B.B.S.
Page views in 2020: 3,890
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Cite this page: Gulwani H. Duodenal peptic ulcer. website. Accessed December 6th, 2021.
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
  • 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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