Clinical recurrence patterns of duodenal ulcer and deformity of the duodenal bulb. a correlative study

A total of 448 patients with endoscopically healed duodenal ulcer received regular follow-up for 3 to 8 years. Eighty-seven (19.4%) of them never experienced recurrence (group 1), 39 (8.7%) had only once recurrence during the follow-up course (group 2), 269 (60.1%) recurred periodically or irregularly (groups 3 and 4), and 53 (11.8%) needed surgical operation finally (group 5). Group 1 patients consisted of 69% of patients with normal-shaped bulb (type I) and 31% with mild degree of bulbar deformity (type II). Group 5 included 54.7% of patients with marked deformity of the bulb (type III). In average, the type I ulcer patients were the youngest and the type III ulcer patients the eldest (with statistical significance). The mean age of groups 1 and 2 was significantly younger than that of groups 4 and 5 (P<0.01 in each). Male was more prominent in group 5 than group 1(P<0.05). Twenty-two (4.9%) of these 448 patients changed from type I to type II (17 cases) or from type II to type III (5 cases), 1 to 5 years later. In general, patients with type I ulcer seemed to have a larger chance to be cured but does not necessary approve a better prognosis in individual cases. Markedly deformed bulb (type III) probably is one of the important factors leading the duodenal ulcer to recur or even to going to the condition needs surgical intervention.