Abstract
Considerable time has passed, since endoscopy was introduced for the routine examination of duodenal ulcer, and endoscopic follow-up cases have been accumulated. The authors studiedd the course of 246 duodenal ulcer cases observed by endoscopy (1031 examinations). Short course. A healing ratio of duodenal ulcer was 56% for the period of 4 weeks, 60% for 8 weeks and 67% for 12 weeks. A considerable number of ulcers healed before 4 weeks elapsea, but after that, an increase in healing ratio became slower. At any time point the healing ratio of single ulcer was highest and that of linear ulcer lowest. Long Course. A recurrence ratio was separately calculated for each observation period; 20% up to 1 year, 41% up to 2 years, 57% up to 3 years and 68% up to 4 years. The ratio was almost equal to that of gastric ulcer. It was lowest in single ulcer and highest in linear ulcer in all the periods. The site of recurrence was the same as or close to that of former ulcers in most cases. In cases of kissing ulcers recurrence usually occured in one of the ulcers. Nearly 50% of the ulcers unhealed during the observation period were linear ulcers. Ridge formation is one of the characteristic endoscopic findings in duodenal ulcer. This was not always persistent but fluctuating in 30%. Most of ridge formation were found in linear or kissing ulcers but it sometimes occurred in single ulcer. This seems to be caused not only by scar formation but also by functional abnormality. Ridge formation was a little more often in recurrent and unhealed groups than in healed and "remaining healed" groups, but this finding did not help much in estimating a prognosis of duodenal ulcer. Scattered erosions-so called "shimof uri"-were found in 17% of all cases, persistent ly seen in only 7 % of them and fluctuating in the others during the observation period. These were found in any types of ulcer, most frequently in linear ulcer and most often associated with an ulcer at healing stage. Ulcer improved in 48% endoscopically after scattered erosions appeared. A history of overt bleeding was found in 25.2 % in the present series. Forty per cent of them had more than 2 episodes. In 55% overt bleeding was the initial symptom of duodenal ulcer.
