Gastric carcinoma in patients with unoperated duodenal ulcer disease.

Gastric cancer may develop in the presence of active or chronic duodenal ulcer disease in the unoperated stomach. This association is considered rare, especially since the presence of a duodenal ulcer is believed to protect against the development of a gastric malignancy. In this review, we describe two patients in whom gastric cancer was diagnosed after a long history of duodenal ulcer disease. Also presented is a review of 236 additional cases from the literature Patients with gastric cancer associated with duodenal ulcer disease tended to be younger than patients who develop gastric cancer not associated with duodenal ulcer. When compared to patients with gastric remnant (stump) cancer, the latency from onset of ulcer symptoms to the diagnosis of gastric cancer was shorter than the latency for stump cancer development, but the risk of developing stump cancer appears to be greater. The natural history and prognosis of this entity is otherwise similar to gastric cancer unassociated with duodenal ulcer and to stump cancer. A change in ulcer symptoms is an insensitive clue to the presence of gastric cancer in this group. The diagnosis may be delayed in some individuals whose gastric cancers respond to cimetidine or other agents.