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DUODENITIS AS A DIFFERENTIAL DIAGNOSIS OF DUODENAL ULCER
O P Kapoor
Hon. Visiting Physician, Jaslok Hospital and Bombay Hospital, Mumbai,
Ex. Hon. Prof. of Medicine, Grant Medical College and JJ Hospital, Mumbai 400 008.
In the past I used to teach that ankylostoma duodenalis infestation of the duodenum leading to duodenitis is a very strong differential diagnosis of duodenal ulcer. The suspicion of this diagnosis increases if the patient (specially male) has on general examination, anaemia and the patient is a farmer who comes from a village and does not use shoes or chappals. In the modern days I hardly see patients of ankylostoma infestation because of the extensive use of Albendazole.In the last 2 years I have seen three patients of strongyloides stercoralis who have presented with symptoms of severe duodenitis (upper most jejunum). Although, even the latest editions of Davidson, Harrison and Oxford do not stress this point, the strongyloides infestation of this site produces severe pain and vomiting due to duodenitis and upper jejunitis.
Fortunately, these patients could be picked up on a routine gastroscopy done by an experienced endoscopist who can also take smear from a distal part of the duodenum and show presence of strongyloides. Ba meal pictures of these areas are supposed to be diagnostic of strongyloides infestation showing a dilatation of the involved area. Unfortunately, none of the undergraduate or post-graduate text books have even shown the picture of this which is nearly diagnostic of this condition.
The best treatment of strongyloides is Ivermectin in a single dose of 200 mg/kg. At present this drug is not available in India and the doctors are using Albendazole or Thiobendazole, both of which are weakly effective. With the increasing incidence of HIV, we are likely to see many more patients suffering from strongyloides.
Aspirin and NSAIDs are the third differential diagnosis of duodenal ulcer, but they mainly cause gastritis.
ACKNOWLEDGEMENTS
I acknowledge the help rendered by Dr. Sunil Parekh and Dr. Sameer Parekh.
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