Re: Duodenal ulcer without Hp or hypergastrinemia??

Posted By Jeff Johnson on July 19, 1999 at 09:46:28

Four years ago I was dx'ed with a duodenal ulcer on upper
GI series.  After triple therapy, I still had symptoms so
I was referred to a gastro for an endoscopy.  He found no
ulcer, mild duodenititis, moderate antral gastritis, and
some hyperplastic polyps.  A biopsy of the antrum was
negative on an Hp urease test.  The polyp path. report
was "no atypia found". Gallbladder tests were normal.
I'm now having ulcer-like symptoms again, but an Hp IGG
serum antibody test was negative last year.  An immediate
care doc ordered a gastrin level test which was 77 (I think
normal was < 110.  All bloods came back normal except for
lipase which was a 7 (normal was 8 to a large number).
I've been taking Prilosec for a week with no improvement.
(If anything I think the Prilosec is giving me some symptoms
similar to IBS.)
I'm seeing my gastro later this week, but frankly I'm confused.
Why a DU with no Hp?  Does a normal gastrin level rule out a
gastrinoma?  I have no family history of any kind of cancer,
but a bunch of bad gallbladders on my dad's side.
At the time, hyperplastic polyps were considered no big deal
but now I'm finding citations in the literature which indicates
they can and do turn malignant.  Any comments?
Thanks.

[HFHSM.D.-rf]

Posted By HFHSM.D.-Gastro-RF on August 02, 1999 at 07:14:18
Dear Jeff,
You are correct that the majority of duodenal ulcers (approx 90-95%) are related to H, pylori infection.  Gastrinoma is an extremely unusual cause for duodenal ulcers.  The use of nonsteroidal agents e.g naprosyn, aspirin, motrin can cause ulcers.  If you are using such medication, then you should stop.
I agree that a repeat endoscopy is needed to confirm whether a recurrence of the ulcer is responsible for your symptoms.  If ulceration is not found, then another cause for the pain should be sought.
This information i spresented for educational purposes.  Ask specific questions to your personal physician.
HFHSM.D.-gastro-RF
*keywords: duodenal ulcer
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