## Analysis of Peptic Ulcer Pathophysiology ### Duodenal vs Gastric Ulcers: Key Distinctions | Feature | Duodenal Ulcer | Gastric Ulcer | |---------|---|---| | **Prevalence** | More common (60% of PU disease) | Less common (30% of PU disease) | | **H. pylori association** | ~90% | ~70% | | **Malignant potential** | None (benign by definition) | ~3–5% risk of malignancy | | **Perforation risk** | Higher (anterior wall duodenal ulcers) | Lower | | **Bleeding risk** | Moderate (gastroduodenal artery) | Higher (left gastric artery) | | **Location** | Duodenal bulb (most common) | Lesser curve, antrum | ### Critical Point on Perforation **Key Point:** Duodenal ulcers have a HIGHER risk of perforation (especially anterior wall ulcers eroding into the peritoneal cavity), while gastric ulcers have a higher risk of bleeding (due to proximity to the left gastric artery) and malignant transformation. ### Why Option 2 is Incorrect **High-Yield:** The statement "Duodenal ulcers have a higher risk of perforation compared to gastric ulcers" is **TRUE**, not false. Anterior duodenal ulcers perforate into the peritoneal cavity causing acute peritonitis. Gastric ulcers, by contrast, more commonly bleed or erode into adjacent structures (pancreas, liver) rather than perforate acutely. ### Why Option 3 (The Correct Answer) is Wrong **Key Point:** Gastric ulcers carry a 3–5% risk of malignant transformation to gastric adenocarcinoma. This is a critical clinical distinction: gastric ulcers must be endoscopically followed after healing to exclude underlying malignancy. Duodenal ulcers, being benign by definition, do NOT undergo malignant transformation. ### Clinical Correlation **Clinical Pearl:** When a gastric ulcer is identified on endoscopy, multiple biopsies from the ulcer margin and base are mandatory to exclude gastric cancer. Duodenal ulcers do not require this surveillance. [cite:Harrison 21e Ch 297]
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