POST-BULBAR AND COEXISTING ULCERATION - UNIQUE FEATURES OF PEPTIC-ULCER IN HYDERABAD

Post-bulbar ulceration is uncommon, but a pilot study in Hyderabad sho wed a high incidence. We therefore carried out a prospective endoscopi c study of the distribution of peptic ulceration and its relation to s ymptoms and demography. Of the 360 consecutive patients referred for e ndoscopy, 113 (92 men, 21 women) had peptic ulceration. Median age 35 years, median duration one year. Five patients (4%) had gastric ulcer, 77 (68%) had duodenal ulcer, and 31 (28%) had coexisting gastric and duodenal ulcer. The duodenal ulcer was found in the pyloric canal in 1 4% of patients, in the bulb in 80%, and the post-bulbar region in 56% of patients. Sixty seven per cent of duodenal ulcers were located at m ore than one site. The incidence of post-bulbar v bulbar ulcer was 1:1 .5. Deformed bulb was seen in 50% of duodenal ulcer patients, but haem orrhage and stenosis were uncommon. Except for nocturnal pain, there w ere no differences in symptoms between the groups. Forty two per cent of patients smoked, 15% chewed tobacco, and 18% drank alcohol; almost all were men. Sixty four per cent drank tea. The staple diet (85%) was rice, and 70% used tamarind and spices daily. Duodenal ulcer was thre e times more common than gastric ulcer with a high incidence of post-b ulbar and coexisting ulcer. It affected a younger and predominantly ma le population, and was not associated with a higher rate of complicati on.