From the Guidelines
A kissing duodenal ulcer is a pair of ulcers that develop opposite each other on the anterior and posterior walls of the duodenum, typically in the duodenal bulb, and can increase the risk of complications like bleeding, perforation, or duodenal stenosis. These ulcers usually result from the same factors that cause single duodenal ulcers, including Helicobacter pylori infection, NSAID use, or excessive acid production 1. The treatment typically involves a proton pump inhibitor (PPI) such as omeprazole 20mg twice daily for 4-8 weeks, combined with antibiotics if H. pylori is present (clarithromycin 500mg, amoxicillin 1000mg, and a PPI, all twice daily for 14 days) 1. Some key points to consider in the management of kissing duodenal ulcers include:
- Avoiding NSAIDs, alcohol, smoking, and spicy foods during healing
- Endoscopic evaluation for diagnosis and to rule out malignancy, especially in older patients or those with concerning symptoms like weight loss or persistent vomiting 1
- Prompt recognition and treatment of complications to improve outcomes, especially in elderly and frail patients 1. It's also important to note that the incidence pattern of peptic ulcer disease is evolving in relation to the rise of new risk factors, such as the increasing incidence of Helicobacter pylori infection, the extensive use of NSAIDs, and the increase in alcohol and smoking abuse 1.
From the Research
Definition of Kissing Duodenal Ulcer
- A kissing duodenal ulcer refers to a rare condition where two duodenal ulcers, one anterior and one posterior, are present in the duodenum and are in close proximity to each other, often causing significant surgical challenges and high morbidity and mortality 2.
Characteristics and Treatment
- Kissing duodenal ulcers are often associated with refractory peptic ulcer disease and can require emergency treatment, including pancreas-sparing duodenectomy 2.
- The treatment of kissing duodenal ulcers often involves a combination of medical and surgical approaches, including the use of proton pump inhibitors and antibiotics to eradicate Helicobacter pylori infection, which is a common cause of duodenal ulcers 3, 4, 5, 6.
Complications and Outcomes
- Kissing duodenal ulcers can lead to significant complications, including perforation, bleeding, and obstruction, and can have a high mortality rate if left untreated or if treatment is delayed 2.
- The outcome of treatment for kissing duodenal ulcers depends on various factors, including the severity of the condition, the presence of underlying medical conditions, and the effectiveness of the treatment approach used 2.