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Case 24: Epigastric discomfort and anaemia

An 82 year old lady was anaemic and had recent trouble with epigastric discomfort. She was worried if she would be fit enough for major surgery if something sinister was found in her stomach at endoscopy. This is a view of her duodenum.

1. Describe the appearance of the lesion

In the first part of the duodenum there is a shallow ulcer. The edges are smooth, rounded and seem inflammatory in nature. It is difficult to see on this image, but there is no adherent clot, bleeding or visible vessel.

1. What would you do at endoscopy, and what further treatment would you advise?

No treatment to the ulcer in the absence of hard signs of bleeding. A biopsy of the gastric antrum for helicobacter pylori and then treat with Proton Pump Inhibitors and H.Pylori eradication if present. Also discontinue NSAIDS, and rescope to confirm healing.

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