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Duodenal ulcer

A patient, 56 years old, diagnosed with duodenal ulcer 6 months ago. Biopsy showed the presenc of Helicobacter pylori, which was treated with amoxicillin, clarithromycin and omeprazole. After treatment, the patient remained to complain burning symptoms even taking omeprazole. In a new investigation, two tests were done: rapid urease test which was negative and serology for H. pylori which was positive.

- Do you suggest new treatment for H. pylori?

- Do you suggest surgery for this patient?

- What are the surgical options for this case?

Tags: duodenal, general, surgery, ulcer

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Permalink Reply by Alam SE on March 3, 2013 at 10:52pm

I will suggest another eradication regimen besides OAC (like BMT or LAC regimen), the positive serology with negative urea breath test is suggestive of ongoing H.pylori activity in case of atrophic gastritis. So we need to eradicate infection with another regimen (current infection resistant to previous regimen).

I will not suggest surgery , as surgery is only indicated in case of H.pylori when there is gastric ulcer and suspicion of malignancy, as duodenal ulcers are never malignant , so I will not suggest surgery.

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Permalink Reply by Alam SE on March 3, 2013 at 11:06pm

we dont need surgery for ulcer per se, but for increased acidic symptoms one can do superselective vagotomy.

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Permalink Reply by Ashish Patil on March 3, 2013 at 11:58pm

The serology is highly sensitive test but if a person had a previous H Pylori infection, it will be be positive.

The urease breath test turning from positive to negative indicates that the patient has responded to the OAC regimen.

First thing I would like to ask the patient whether the symptoms have improved. If the symptoms persist as seen in this case, reevaluate the patient for Zollinger Ellison syndrome.