Postbulbar Duodenal Ulcer and Ring-Stricture

Bilbao, Marcia K.; Frische, Louis H.; Rösch, Josef; Benson, John; Dotter, Charles T.

doi:10.1148/100.1.27

Cited by 24 publications

(8 citation statements)

References 4 publications

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“…Traditionally, PBDUs are thought to occur much less frequently in comparison to ulcers of the duodenal bulb, accounting for 5–10% of overall DUs and to possess a greater bleeding tendency in comparison to other ordinary DUs 12–15 . However, the majority of these studies were performed in the 1950s to 1980s, and in all of these studies, the diagnosis of PBDU was made without endoscopy, based on autopsy, surgical findings, and roentgenography 12–22 . In addition, no studies have focused on the nature of endoscopic treatment or its outcomes in patients with bleeding PBDUs.…”

Section: Introductionmentioning

confidence: 99%

Nature and treatment outcomes of bleeding post‐bulbar duodenal ulcers

Matsuhashi

Fukuda

Abe

et al. 2021

Digestive Endoscopy

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Background Although post‐bulbar duodenal ulcers (PBDUs) could become a source of upper gastrointestinal bleeding, the whole picture of the disease is unknown. We compared the characteristic features and treatment outcomes after endoscopic hemostasis between PBDUs and bulbar duodenal ulcers (BDUs). Methods Data on duodenal ulcers with evidence of endoscopically‐active bleeding were extracted from the data that were retrospectively collected from 12 institutes in Japan between 2011 and 2018. Rebleeding and in‐hospital mortality were compared between patients with PBDUs and those with BDUs by logistic regression analyses. Results Among 468 consecutive patients with bleeding duodenal ulcers, 96 (20.5%) had endoscopically‐confirmed PBDUs. PBDUs were more frequently observed in patients with a poor general condition in comparison to BDUs. The rates of rebleeding and in‐hospital mortality in patients with PBDUs were approximately three times higher than those in patients with BDUs (PBDU vs. BDU: 29.2% vs. 10.2% [P < 0.0001] and 14.6% vs. 5.1% [P = 0.0029], respectively). Although the high in‐hospital mortality in PBDUs could be explained, to a lesser extent, by the likelihood of rebleeding, and, to a greater extent, by the patients' poor general condition, the presence of a PBDU itself was largely responsible for the high rebleeding rates in PBDUs. Conclusion This is the first study focusing on the nature and treatment outcomes of bleeding PBDUs. PBDUs were associated with much higher rebleeding and mortality rates in comparison to BDUs, and the likelihood of rebleeding may be derived from their unique anatomic location.

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Section: Introductionmentioning

confidence: 99%

Nature and treatment outcomes of bleeding post‐bulbar duodenal ulcers

Matsuhashi

Fukuda

Abe

et al. 2021

Digestive Endoscopy

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“…Therefore, some researchers [ 13 , 14 ] speculated that the acquired pathogenesis is related to NSAIDs ingestion. In 1971, Bilbao et al [ 15 ] described a large series of 12 ring-like strictures in the descending duodenum with postbulbar duodenal ulcers. Although some hypotheses of acquired pathogenesis in duodenal diaphragms have been made, it is still unclear whether NSAIDs were an etiologic factor or not.…”

Section: Discussionmentioning

confidence: 99%

A rare case of duodenal diaphragm in an adult during ERCP treatment for choledocholithiasis

Jia

et al. 2020

BMC Surg

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Background Duodenal Diaphragm in adults is very uncommon, caused by congenital and acquired changes. It is reported that acquired duodenal diaphragm is related to the long-term use of nonsteroidal anti-inflammatory drugs. Case summary We report an adult presentation of duodenal diaphragm in a 77-year-old woman, suffered from acute cholangitis and choledocholithiasis. She was performed endoscopic retrograde cholangiopancreatography (ERCP) procedure to remove the stone in common bile duct (CBD). After the stenosis ring dilated by endoscopic balloon dilatation, ERCP procedure was applied, and the CBD stone was removed successfully. Conclusion Duodenal diaphragm is difficult to diagnose in clinic. Although the patient in this case had relatively mild symptoms of incomplete upper hemi-abdominal obstruction, these symptoms could be obscured by the emergency acute upper abdominal pain with fever as clinical manifestations of acute cholangitis.

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“…Therefore, some researchers [2,3] proposed that the acquired pathogenesis is related to nonsteroidal antiinflammatory drug ingestion. In 1971, Bilbao et al [5] described a large series of 12 ringlike strictures of the descending duodenum seen with postbulbar duodenal ulcers. Al- though these researchers also proposed the acquired pathogenesis of duodenal diaphragms, it is unclear as to whether nonsteroidal antiinflammatory drugs were an etiologic factor.…”

Section: Mr Imaging Of Bilateral Renal Malacoplakia After Liver Transmentioning

confidence: 99%

“…In these reports, four of five patients were known to be treated with warfarin sodium, implicating the drug as an etiologic agent [3,4]. Subsequent work showed an increased incidence of tracheobronchial calcification in adults receiving warfarin sodium versus that in age-matched control subjects (47% versus 19%, respectively) [5].…”

Section: B Amentioning

confidence: 99%