Gastroduodenitis. A broader concept of peptic ulcer disease

To evaluate the frequency and type of gastroduodenal mucosal inflammatory changes in patients with symptomatic acid peptic disease and nonulcer dyspepsia, 100 patients with gastrointestinal symptoms indicative of acid peptic disease or dyspepsia and 10 control subjects were clinically evaluated and underwent radiographic, endoscopic, and biopsy studies of the stomach and duodenum. Clinical evaluation revealed that of the 100 patients, 61% had classic and 39% had atypical manifestations of acid peptic (ulcer) disease. Endoscopic and histologic evaluation revealed that 25 patients had peptic ulcer craters, 86-90% of whom had associated gastroduodenitis. Thirty-nine patients had acute and 20 patients had chronic gastroduodenitis without ulcer crater. Twelve symptomatic patients had no histologic changes in the gastroduodenal mucosa. Two of the ten control subjects had mild gastritis. In the 61% of the patients with classic manifestations of peptic ulcer disease, we could not clinically distinguish the 24 patients with craters, (40% of the classic group) from the 25 patients with acute gastroduodenitis without craters (41% of the classic group). As a result of this study of our group of patients, we believe that gastroduodenitis can be symptomatic and may present with the same manifestations as peptic ulcer crater. Further study will be required to determine whether gastroduodenitis is an independent entity or part of the spectrum of acid peptic (ulcer) disease.