Coexistent duodenal ulcer among patients with gastric carcinoma

To examine the prevalence of coexistent duodenal ulcers among patients with gastric carcinoma in an otherwise intact stomach, we surveyed 604 endoscopically and pathologically diagnosed gastric carcinoma patients and thoroughly inspected their duodenums. Twenty-two (3.6%) of them had either active ulcers or scars in the duodenum. This prevalence was significantly less than that among 99 (16.4%) of 604 age- and gender-matched controls with endoscopically confirmed duodenal ulcers (P < 0.0001). Almost one-half of patients with coexistent cancer and duodenal ulcer experienced no change in abdominal symptoms when gastric cancer was diagnosed. Barium meal study appeared not to be sensitive enough to diagnose the coexistent ulcers. However, the nature of the lesions, including disease location, macroscopic appearance, chance of early cancer and metastasis, was no different in 22 patients with coexistent cancer and duodenal ulcer than in 582 patients with cancer alone. The present study suggests that although duodenal ulcer is unlikely to be a predisposing factor for gastric cancer, thorough screening by means of endoscopy is necessary in dyspepsic ulcer patients since duodenal ulcer and gastric cancer are not incompatible.