Definition

 • Inflammation or ulceration of the duodenal mucosa due to excess gastric acid.

Epidemiology

• Common, affecting up to 10% of the population.

 • Mostly seen in male patients aged >40 y.

 Aetiology

 • Chronic H. pylori infection is thought to be the key aetiological factor.

• Smoking and NSAIDs are also major risk factors.

• recurrent multiple duodenal ulcers, particularly if present beyond the first part of the duodenum, should raise suspicion of possible Zollinger– ellison syndrome .

Pathogenesis

 • Increased gastric acid production causes injury to the duodenal mucosa, varying from mild erosions only through to severe ulceration.

 Presentation

• Burning epigastric pain relieved by eating.

 • Severe cases cause persistent epigastric pain, nausea, and vomiting.

Macroscopy

 • Peptic duodenitis shows mucosal erythema ± superficial erosions.

 • Peptic ulcers appear as well- circumscribed, punched- out mucosal defects with granulation tissue at the base.

 Histopathology

 • Peptic duodenitis shows acute inflammation, oedema, and haemorrhage in the lamina propria. the surface epithelium typically shows areas of gastric metaplasia. H. pylori organisms may be identified overlying the metaplastic gastric epithelium.

• Peptic ulcers show complete loss of the whole mucosal layer, with replacement by granulation tissue and underlying scar tissue.

 Prognosis

 • eradication of H. pylori and acid suppressive therapy improves symptoms and leads to healing.

 • Scarring of ulcers can lead to stricture formation and obstruction.

• Breach of a large vessel by a peptic ulcer is a common cause of acute upper GI haemorrhage.

 • free perforation causes acute generalized peritonitis, necessitating urgent surgical intervention.

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