A 38-year-old woman and a 29-year-old man were referred to our hospital for abdominal pain. In both cases, gastroendoscopy revealed a duodenal ulcer. H. pylori and NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) intake history were negative in both cases. These duodenal ulcers were refractory even with PPI (Proton Pump Inhibitor) treatment for a few months. Colonoscopies were performed for further evaluation, and they showed vascular pattern loss and fine granular mucosal pattern. From colonoscopy and histopathological examination of the colon, we diagnosed them as ulcerative colitis. Mesalazine therapy was started, and mucosal inflammation of the duodenum and colon gradually subsided. Histopathological examinations of duodenal biopsy showed basal plasmacytosis and crypt distorsion, which is characteristic in gastroduodenitis associated with ulcerative colitis. Therefore, we diagnosed these duodenal ulcers as gastroduodenitis associated with ulcerative colitis. When we see a refractory duodenal ulcer without H. pylori infection and NSAIDs intake, we should consider the coexistence of ulcerative colitis.
