抄録
A 44-year-old man visited our hospital due to the epigastralgia. An endoscopic examination revealed an active gastric ulcer in the antrum of the stomoch and a healing ulcer in the duodenal bulb. Despite that either H2 receptor antagonists or proton pump inhibitors had been administered, none of them had been effective enough for ulcers to be cured. An endoscopic examination after 17 months of the conventional therapy revealed the gastroduodenal fistula, so-called the double pylorus.
Because he was found to be positive for Helicobacter pylori by the culture of gastric biopsy specimen as well as pathologically, he received an eradication therapy of H. pylori with omeprazole 40mg plus amoxiciline 1500mg for 14 consecutive days. The therapy brought both ulcers to be cured with red scars and set the patient free from the symptom although the ulcers were recurrent after 12 weeks. Due to his request, recradication therapy was done with omeprazole 40mg, amoxicilin 1,500mg plus clarithromycin 400mg for 14 consecutive and had brought the ulcers to be cured with white scars and negative for H. pylori. The ulcers have never been recurrent and remained scars since re-eradication therapy.
This case is considered rare and worth to report because it had been able to observe that the intractable gastroduodenal ulcers had become the gastroduodenal fistula“the double pylorus”and the eradication of H. pylori had been effective for preventing the intractable ulcers from recurring.
