Duodenal Ulcer, El Salvador Atlas of Gastrointestinal VideoEndoscopy. A Large Database of Images and Video Clips with Cases Reported.
El Salvador Atlas of Gastrointestinal VideoEndoscopy
Duodenal Ulcer with Visible Vessel. This 65 year-old male with longstanding symptoms of gastro esophageal reflux disease, patient presented with melena, two years ago a surgical excision of melanoma malignant of its left leg was performed. Approximately nine years ago, a duodenal ulcer was found at endoscopy.

Video Endoscopic Sequence 1 of 4.

Duodenal Ulcer with Visible Vessel.

 This 65 year-old male with longstanding symptoms of
 gastroesophageal reflux disease, patient presented with
 melena, two years ago a surgical excision of melanoma
 malignant of its left leg was performed. Approximately nine
 years ago, a previous duodenal ulcer was found at
 endoscopy.

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 video clips. We recommend seeing the video clips in full
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More images and video clips of this case.

Video Endoscopic Sequence 2 of 4.

More images and video clips of this case.
Endoscopy revealed asymmetric migration of metaplastic epithelium upward into the esophagus. Biopsies confirmed the presence of intestinal metaplasia diagnostic of Barrett's disease.

Video Endoscopic Sequence 3 of 4.

 Endoscopy revealed asymmetric migration of metaplastic
 epithelium upward into the esophagus. Biopsies confirmed
 the presence of intestinal metaplasia diagnostic of Barrett's
 disease.

 
Enhanced Magnification endoscopy. Zoom endoscopy of a tongue of Barretts mucosa showing cerebriform villous architecture.

Video Endoscopic Sequence 4 of 4.

Enhanced Magnification endoscopy.

 Zoom endoscopy of a tongue of Barretts mucosa showing
 cerebriform villous architecture.

 
Duodenal Ulcer. Helicobacter pylori infection, now considered to be a cause of gastric cancer, is also strongly associated with gastric and duodenal ulcer disease.

Video Endoscopic Sequence 1 of 3.

Duodenal Ulcer.

 Helicobacter pylori infection, now considered to be a cause
 of gastric cancer, is also strongly associated with gastric
 and duodenal ulcer disease.

                                         Medline.

 
Deformed duodenal bulb due to a duodenal ulcer. Duodenal ulcer (DU) is a common condition characterized by the presence of a well-demarcated break in the mucosa that may extend into the muscularis propria of the duodenum. More than 95% of DUs are found in the first part of the duodenum; most are less than 1 cm in diameter.

Video Endoscopic Sequence 2 of 3.


 The image and the video clip display a deformed duodenal
 bulb due to a duodenal ulcer.

 Duodenal ulcer (DU) is a common condition characterized by the
 presence of a well-demarcated break in the mucosa that may
 extend into the muscularis propria of the duodenum. More than
 95% of DUs are found in the first part of the duodenum; most are
 less than 1 cm in diameter.

 
Duodenal ulcer after spraying methilene blue. Pathophysiology: The duodenal mucosa resists damage from the effect of aggressive factors, such as gastric acid and the proteolytic enzyme pepsin, with the help of several protective factors such as a mucous layer, bicarbonate secretion, and protective prostaglandins.

Video Endoscopic Sequence 3 of 3.

 Duodenal ulcer after spraying methilene blue.

 Pathophysiology: The duodenal mucosa resists damage from the
 effect of aggressive factors, such as gastric acid and the
 proteolytic enzyme pepsin, with the help of several protective
 factors such as a mucous layer, bicarbonate secretion, and
 protective prostaglandins.

Multiple Duodenal ULcers. Duodenal ulcer (DU) is a common condition characterized by the presence of a well-demarcated break in the mucosa that may extend into the muscularis propria of the duodenum. More than 95% of DUs are found in the first part of the duodenum; most are less than 1 cm in diameter. Causes: The understanding of the etiology of DU has changed dramatically in the latter part of the 20th century. Historically, DU was thought to be a disease related to diet and environmental stress alone. Subsequent studies revealed the importance of pepsin and acid secretion in the pathogenesis of DU. The most revolutionary change in the knowledge of DU was the discovery in 1982 that the bacterium H pylori was present in most patients with DU.

Video Endoscopic Sequence 1 of 2.

 Multiple Ulcers of the duodenal bulb.

 Duodenal ulcer (DU) is a common condition characterized by
 the presence of a well-demarcated break in the mucosa that may
 extend into the muscularis propria of the duodenum. More than
 95% of DUs are found in the first part of the duodenum; most are
 less than 1 cm in diameter Causes: The understanding of the
 etiology of DU has changed dramatically in the latter part of the
 20th century. Historically, DU was thought to be a disease related
 to diet and environmental stress alone. Subsequent studies
 revealed the importance of pepsin and acid secretion in the
 pathogenesis of DU. The most revolutionary change in the
 knowledge of DU was the discovery in 1982 that the
 bacterium H pylori was present in most patients with DU.

Duodenal Ulcer and Pseudo Diverticulae. H pylori H pylori are small, microaerophilic, spiral-shaped, gram-negative rods. The presence of H pylori in the stomach and duodenum probably is the most common bacterial infection in the world. H pylori infection is generally regarded as the most important etiologic factor in the development of DU. Most authors regard H pylori as the cause of 85-95% of DUs. H pylori can be cultured from up to 95% of DUs. Moreover, areas with a higher prevalence of H pylori infection have a higher incidence of DU. Several mechanisms exist by which the bacterium can induce duodenal mucosal damage. All evidence supports the assertion that H pylori is the major cause of DU. However, the risk of developing a DU in an individual infected with H pylori is only about 1% per year, and only 10-15% of individuals with H pylori infection develop a DU at any point in life. Therefore, other pathogenic factors must function either independently or in concert with H pylori to produce DUs.

Video Endoscopic Sequence 2 of 2.

 Duodenal Ulcer and Pseudo Diverticulae.

 H pylori

    • H pylori are small, microaerophilic, spiral-shaped, gram-negative rods. The presence of H pylori in the stomach and duodenum probably is the most common bacterial infection in the world. H pylori infection is generally regarded as the most important etiologic factor in the development of DU. Most authors regard H pylori as the cause of 85-95% of DUs.
    • H pylori can be cultured from up to 95% of DUs. Moreover, areas with a higher prevalence of H pylori infection have a higher incidence of DU. Several mechanisms exist by which the bacterium can induce duodenal mucosal damage. All evidence supports the assertion that H pylori is the major cause of DU. However, the risk of developing a DU in an individual infected with H pylori is only about 1% per year, and only 10-15% of individuals with H pylori infection develop a DU at any point in life. Therefore, other pathogenic factors must function either independently or in concert with H pylori to produce DUs.
Mirror Ulcers. Are observed on the opposite wall of the duodenum.

“Mirror Ulcers”.

Are observed on the opposite wall of the duodenum.

 
Duodenal Ulcer that is covered by a moving fold, there are two semicircular ulcers nearby.


 Duodenal Ulcer that is covered by a moving fold, there
 are two semicircular ulcers nearby.


 
Duodenal Ulcer and Pseudo Diverticula. Pseudo diverticular scar of the anterior wall of duodenal bulb due to sequel of duodenal ulcer. A semi circular ulcer is observed.

Duodenal Ulcer and Pseudo Diverticula.

 Pseudo diverticular scar of the anterior wall of duodenal
 bulb due to sequel of duodenal ulcer. A semi circular
 ulcer is observed.

 
Duodenal Ulcers at the bulb Mirror Ulcers. A 33 year-old female from the republic of Costa Rica, living in El Salvador, some antral and chronic erosions and hyperplasia lymphoid was found her brother died of gastric cancer.

Duodenal Ulcers at the bulb “ Mirror Ulcers”.

 A 33 year-old female from the republic of Costa Rica,
 living in El Salvador, some antral and chronic erosions
 and hyperplasia lymphoid was found her brother died of
 gastric cancer. 
 
 

Kissing ulcers. Kissing ulcers of the anterior and posterior walls of the duodenal bulb. The ulcer at the anterior wall is covered with hematin.

 Kissing Ulcers

 Kissing ulcers of the anterior and posterior walls of the
 duodenal bulb.
 The ulcer at the anterior wall is covered with hematin.
Duodenal ulcers that had severe bleeding. The video clip shows pylorus with difigurating scar as sequel of old ulcer.

Duodenal ulcers that had severe bleeding.

 The video clip shows pylorus with difigurating scar as
 sequel of old ulcer.




                                          Medline.

Anterior wall duodenal ulcer with deformed bulb.

Anterior wall duodenal ulcer with deformed bulb.

 

Pseudo diverticular scar. The image and the video clip display a pseudo diverticular scar of the anterior wall of duodenal bulb due to sequel of duodenal ulcers. A 63 year-old female, she had duodenal ulcers within different time periods.

Pseudo diverticular scar.

 The image and the video clip display a pseudo diverticular
 scar of the anterior wall of duodenal bulb due to sequel of
 duodenal ulcers.
 A 63 year-old female, she had duodenal ulcers within
 different time periods. 
 
 
Erosive Gastroduodenitis. A 59 year-old male with portal hypertension due to liver cirrhosis.

Erosive Gastroduodenitis.

 A 59 year-old male with portal hypertension due to liver
 cirrhosis.

 
Duodenal ulcer of the anterior wall of the duodenal bulb.

Duodenal ulcer of the anterior wall of the duodenal bulb.

 
Erosive Duodenitis. The etiology of duodenitis is not completely understood. However, the gastric acid hypersecretion and the helicobacter pylori play an important role in the pathogenesis.

Erosive Duodenitis.

 The etiology of duodenitis is not completely understood.
 However, the gastric acid hypersecretion and the
 helicobacter pylori play an important role in
 the pathogenesis.
Brunner gland hyperplasia. Brunner gland hyperplasia in the duodenal bulb with associated giardia lamblia infection. Giardia lamblia is prevalent throughout the world. In the developing countries the prevalence rates are high. These organism infects the small intestine and may cause acute diarrhea. Frequently there is sudden of explosive, watery, foul-smelling diarrhea accompanied by abdominal distention and flatulence or chronic malabsorption, abdominal pain or any class of dyspepsia.

 Brunner Gland Hyperplasia.

 Brunner gland hyperplasia in the duodenal bulb with
 associated giardia lamblia infection.
 Giardia lamblia is prevalent throughout the world.
 In the developing countries the prevalence rates are high.
 These organism infects the small intestine and may cause
 acute diarrhea. Frequently there is sudden of explosive,
 watery, foul-smelling diarrhea accompanied by
 abdominal distention and flatulence or chronic
 malabsorption, abdominal pain or any class of dyspepsia.

Brunner?s gland adenomata. Brunner's gland adenomas are uncommon benign duodenal tumors. They are an infrequent cause of upper gastrointestinal hemorrhage and duodenal obstruction.

Brunner’s Gland “Adenomata”

 Brunner's gland adenomas are uncommon benign
 duodenal tumors. They are an infrequent cause of upper
 gastrointestinal hemorrhage and duodenal obstruction.

Posterior wall duodenal ulcer and pseudo diverticula, duodenal bulb due to an old scar at the anterior wall.



 Posterior wall duodenal ulcer and pseudo diverticula,
 duodenal bulb due to an old scar at the anterior wall.

Endoscopic intervention in acute gastrointestinal bleeding due to duodenal ulcer of the posterior wall. This sequence of endoscopies display an interventional therapy in which the ulcer is injected with alcohol.

Video Endoscopic Sequence 1 of 4.

 Endoscopic intervention in acute gastrointestinal
 bleeding due to duodenal ulcer of the posterior wall.
 This sequence of endoscopies display an interventional
 therapy in which the ulcer is injected with alcohol.
  
 
                                          Medline.

After suction of the blood, the image becomes more clearly. The ulcer is seen with some blood inside. Endoscopic treatment of an exposed or visible vessel in a large, deeply penetrating, posterior duodenal bulb ulcer may cause significant bleeding if a large serosal artery, the gastroduodenal artery, is involved.

Video Endoscopic Sequence 2 of 4.

 After suction of the blood, the image becomes more
 clearly.
 The ulcer is seen with some blood inside.
 Endoscopic treatment of an exposed or visible vessel in
 a large, deeply penetrating, posterior duodenal bulb
 ulcer may cause significant bleeding if a large serosal
 artery, the gastroduodenal artery, is involved.
The ulcer is observed in the posterior wall of the duodenal bulb, Bleeding actively, for which it needed an emergency procedure to stop the hemorrhage.

Video Endoscopic Sequence 3 of 4.

 The ulcer is observed in the posterior wall of the
 duodenal bulb, Bleeding actively, for which it needed an
 emergency procedure to stop the hemorrhage.


      

Successfully injected, bleeding did not recur. The control of upper gastrointestinal bleeding is one of the fields in therapeutic endoscopy. It is critical that the endoscopist determine whether an ulcer is in the anterior or posterior wall. To inject a vasodestructive solucion (alcohol) is intended to destroy a bleeding vessel.

Video Endoscopic Sequence 4 of 4.

 Successfully injected, bleeding did not recur.
 The control of upper gastrointestinal bleeding is one of
 the fields in therapeutic endoscopy.
 It is critical that the endoscopist determine whether an
 ulcer is in the anterior or posterior wall.
 To inject a vasodestructive solucion (alcohol) is intended
 to destroy a bleeding vessel.    
                                  

                                         Medline.   

Upper gastrointestinal hemorrhage due to duodenal ulcer.

Video Endoscopic Sequence 1 of 4.

 Upper gastrointestinal hemorrhage due to duodenal ulcer.
 

The image and the video display a duodenal ulcer at the anterior wall. The ulcer has some vessels that are the etiology of the bleeding. Argon photocoagulation is carried out for the hemostasis.

Video Endoscopic Sequence 2 of 4.

 The image and the video display a duodenal ulcer at the
 anterior wall. The ulcer has some vessels that are the
 etiology of the bleeding.
 Argon photocoagulation is carried out for the hemostasis.
Therapy with Argon photocoagulation of vessels of duodenal ulcer.

Video Endoscopic Sequence 3 of 4.

 Therapy with Argon photocoagulation of vessels of
 duodenal ulcer.




                                          Medline.

The image and the video display the procedure.

Video Endoscopic Sequence 4 of 4.

 The image and the video display the procedure.





                                           Medline.  
Lymphocytic Duodenitis. This is a type of Duodenitis. with dense infiltration of the surface and foveolar epithelium by T lymphocytes, and associated chronic infiltrates are in the lamina propria Because of similar histopathology relative to celiac disease, lymphocytic gastritis has been proposed to result from intraluminal antigens. High anti-H pylori antibody titers have been found in patients with lymphocytic duodenitis and, in limited studies, the inflammation disappeared after H pylori eradication. However, many patients with lymphocytic gastritis are serologically negative for H pylori. A number of cases may develop secondary to intolerance to gluten and drugs such as ticlopidine.

Lymphocytic Duodenitis.

 This is a type of Duodenitis. with dense infiltration of the
 surface and foveolar epithelium by T lymphocytes, and
 associated chronic infiltrates are in the lamina propria
 Because of similar histopathology relative to celiac
 disease, lymphocytic gastritis has been proposed to result
 from intraluminal antigens. High anti–H pylori antibody
 titers have been found in patients with lymphocytic
 duodenitis and, in limited studies,
 the inflammation disappeared after H pylori eradication.
 However, many patients with lymphocytic gastritis are
 serologically negative for H pylori. A number of cases may
 develop secondary to intolerance to gluten and drugs such
 as ticlopidine.

Micro Erosion of the Duodenal Bulb. This micro erosion is observed using a magnifying endoscope.150x

Micro Erosion of the Duodenal Bulb.

 This micro erosion is observed using a magnifying
 endoscope 150x.
"kissing" duodenal ulcer. Ulcers opposite from each other on the anterior and posterior walls.

"kissing" Duodenal Ulcer

Ulcers opposite from each other on the anterior and posterior walls in the duodenal bulb.