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Table 2: Distinguishing Features of Two Major Forms of Peptic ulcers. 18Part-1Review on Antiulcer LiteratureSr.No.Feature Dudodenal Ulcer Gastric Ulcer1 Incidence Four times common than astriculcers. Usual age 25-50 years.More common in males thanin females ( 4:1)than in females ( 3.5:1)2 Etiology Most commonly as a result ofH. pylori infection. Otherfactors-hyper secretion ofacid-pepsin, association withalcoholic cirrhosis, tobacco,hyperparathyroidism, chronicpancreatitis, blood group O,genetic factorsalcohol, tobacco.3 Pathogenesis Mucosal digestion fromhyperacidity most significantfactor. Protective gastricmucus barrier may bedamaged4 PathologicchangesMost common in the first partof duodenum. Often solitary,1-2.5 cm in size, round to oval,punched out5 Complication Commonly hemorrhage,perforation, sometimesobstruction, malignanttransformation never occurs6 ClinicalfeaturesPain food relief pattern. Nightpain common. No vomiting.Melaena more common thanheamatemesis, No loss ofweight. No particular choice ofdiet. Marked seasonal ariation.Occurs more commonly inpeople at greater stressLess common than duodenalulcers. Usually beyond 6 thdecade. More common in malesGastric colonization with H.pylori asymptomatic but higherchances of development ofduodenal ulcers. Disruption ofmucus barrier most importantfactor. Association withgastritis, bile reflux, drugs,Usually normal-to-low acidlevels: hyperacidity if present isdue to high serum gastrinDamage to mucus barriersignificant factor.Most common along the lessercurvature and pyloric antrum.Grossly similar to duodenalulcersPerforation, hemorrhage and attimes obstruction, malignanttransformation less than 1%cases.Food pain pattern. No nightpain. Vomiting common.Haematemesis more common.Significant loss of weightPatients choose bland dietdevoid of fried food, curriesetc. No seasonal variation.More often in labouring groupsb) Zollinger-Ellison (Z-E) Syndrome:- In this disease, a non-beta cell tumor of thepancreatic islets may produce gastrin in a quantity sufficient to stimulate the secretion ofgastric acid to life-threatening levels. This can lead to severe gastroduodenal ulcerationsand other consequences of the uncontrolled hyerchlorhdria. The therapy is aimed atreducing gastric acid secretion. In this the proton pump inhibitors being surely the drugsof choice. 2 Gastric ECL-cells carcinoids are rare events that have been described inassociation with Z-E syndrome. 195