Duodenal ulcer disease cannot be considered in isolation. Many patients with ulcer-like dyspepsia have no evidence of peptic ulcer on barium meal examination. Some of these patients are found on follow-up to develop evidence of gastric or duodenal ulcer disease, gall bladder or other alimentary disease; others probably have ‘nervous dyspepsia’. Gastric hypersecretion suggests the probable presence, and hyposecretion the probable absence, of an underlying duodenal (or pyloric) ulcer.63 Endoscopists may find ulcers in radiologically normal stomachs and duodenums. Many patients have duodenitis as part of the natural history of duodenal ulcer disease. The symptoms of a patient with duodenal ulcer disease may be caused not only by an ulcer crater, but also by inflammation of the duodenal mucosa. It is not clear whether the symptoms of patients with X-ray-negative, endoscopy-negative, ulcer-type dyspepsia may also be due to duodenitis.
KeywordsPeptic Ulcer Duodenal Ulcer Acid Output Gall Bladder Disease Barium Meal
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