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Difference Between Gastric and Duodenal Ulcers

Gastric vs Duodenal Ulcers

One of the commonest causes of upper abdominal pain, with a burning sensation associated with meals is peptic ulcer disease (PUD). Although, gastric and duodenal ulcers are named as two separate types, they are basically the same disease entity divided due to the site of the lesion. All these are collectively called peptic ulcer disease. The current evidence has shown that this is due to infection by Helicobacter pylori, associated with overuse of NSAIDs. The main differences can be looked at as anatomical, pathological, physiological, clinical and as management. The specifics of each of these aspects won’t be discussed in detail, but a general picture will be drawn regarding these conditions.

Gastric Ulcer

Gastric ulcer is the lesser common variant of PUD, and usually occurs in the older age groups. The ulcer is localized to the lesser curvature of the stomach. If the ulcer had been chronic it can erode the splenic artery on the posterior surface, and cause excessive bleeding. Gastric ulcers, which are chronic, can lead to carcinoma, and thus, these ulcers are considered malignant till otherwise proven.

Duodenal Ulcer

Duodenal ulcers are more common and occur most commonly over the posterior surface of the 1st part of the duodenum. A chronic ulcer can perforate through the mucosa and all the layer, leading to either fibrosis, perforation (anterior), or if related to a vessel profuse bleeding (posterior). The term “kissing ulcers” was brought up to describe anterior and posterior ulcers, which have healed and given rise to fibrosis. Malignancy from chronic duodenal ulcers is very rare.

Difference between Gastric and Duodenal Ulcers

Both types have a common bacterial origin, as well as NSAIDs induced acidity, which causes further progression. Many literature analyses have shown that the two types cannot be distinguished from clinical features alone. They will be presenting with epigastric pain radiating to the back, with eating resolving the pain. Other symptoms like bleeding or vomiting may present with complications like stenosis or perforation. The management is with antisecretory agents and H.pylori eradication regime. Advanced cases may require surgical options to alleviate the condition. If you consider the differences, duodenal ulcers are more common out of the two, also are of smaller diameters. The gastric ulcers appear in the lesser curvature of the stomach, and the duodenal ulcers more commonly appear in the 1st part of the duodenum. Gastric ulcers are prone to have profuse bleeding due to perforation, whereas in duodenal ulcers, you will have perforation, fibrosis, and bleeding. With regards to gastric ulcers, their chronic forms are more likely to develop into cancers than duodenal ulcers.

In summary, most of the differences expounded earlier, as to the clinical differences of the gastric and duodenal ulcers are no longer accepted as demonstrative, and the symptoms are thought to be not very much different. The management principles of these conditions are almost the same, preceded with a similar investigative process. The anatomical location of the ulcer only affects the changes, in pathological, histological, and complications related to the gastric and duodenal ulcers. Thus, gastric ulcers and duodenal ulcers are taken under the umbrella term of peptic ulcer disease.


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