Concomitant gastric and duodenal ulcers

ABSTRACT

Three thousand eight hundred consecutive barium meal examinations performed in the X-ray Department of the University Hospital of the West Indies are analysed. A high percentage of the cases with gastric ulcers were found to have concomitant duodenal ulcers. The relationship between the gastric ulcer and duodenal ulcer in cases with concomitant ulcers is discussed and evidence from the present series and the literature suggests that the gastric ulcer is secondary to the duodenal ulcer in these cases. Two theories of the cause of gastric ulcer, (a) the retention theory and (b) the reflux theory, especially in relation to concomitant gastric and duodenal ulcers, are reviewed. The reflux theory appears to be the most acceptable, and on the basis of this theory, gastric ulcers are classified into (a) primary and (b) secondary (concomitant) to duodenal ulcer or pyloric channel disease (pyloric ulcer or hypertrophic pyloric stenosis). The high incidence of concomitant gastric and duodenal ulcers in Jamaica is compared with the incidence in other countries. It is shown that the incidence of these concomitant ulcers depends upon two factors, which are, the duodenal ulcer, gastric ulcer ratio and the incidence of gastric ulcers which are secondary to duodenal ulcers. In Jamaica, both these factors are high which accounts for the high incidence of concomitant ulcers. (AU)