Nonhealing duodenal ulceration due to candida

An important role for candida in gastric and duodenal ulcer disease is being increasingly recognized. Causative factors implicated include the frequent use of cimetidine, and immunosuppressive or antibiotic therapy. Concerning cimetidine, there is no clear-cut evidence that the drug depresses cell mediated immunity; on the contrary, there is evidence that delayed hypersensitivity is enhanced. Acid reduction is the alternate and more likely explanation for any role of cimetidine in gastric and duodenal candidiasis. We report a patient with a duodenal ulcer, which repeatedly bled and failed to heal in hospital on standard antacid and cimetidine therapy. Candida was identified in the ulcer and treated, using mycostatin suspension, resulting in complete healing. We feel that candida involvement of duodenal ulcers may be more common than is generally recognized, and may be the cause for nonhealing in certain patients already on optimum therapy.