Duodenal Ulcer Endoscopic Staging: Understanding the Healing Process

Endoscopic evaluation plays a crucial role in assessing the progression and healing stages of a duodenal ulcer. Typically, the condition is classified into three distinct phases during endoscopy: the acute phase, the healing phase, and the scar phase. Each stage reflects the ulcer's development and recovery, offering valuable insight for medical professionals managing the disease.

The Acute Phase

During the acute phase, a freshly formed ulcer is typically observed with a thick white or yellow coating covering the affected area. This layer, known as fibrin exudate, is often accompanied by noticeable swelling or edema around the ulcer site. The surrounding mucosa may appear inflamed, and the lesion itself tends to be well-defined with raised borders. This stage indicates active tissue damage and requires prompt medical attention to prevent complications.

The Healing Phase

As the ulcer begins to heal, the thick white coating gradually diminishes or disappears entirely. The surface of the ulcer becomes thinner, and signs of tissue regeneration start to appear. Although the lesion is in the recovery process, some superficial erosions may still be present. Additionally, the surrounding area often shows signs of redness due to increased blood flow, a condition known as perilesional hyperemia. This phase indicates a positive response to treatment but requires continued monitoring.

The Scar Phase

In the scar phase, the ulcer has largely healed, and the inflammation and swelling previously observed are no longer present. At this stage, the affected area is typically marked by fibrous, red linear scars. These scars represent the final stage of tissue repair and are generally stable. The mucosa surrounding the scar appears normal, with no signs of active inflammation or erosion.

Importance of Endoscopic Staging

Accurate endoscopic staging of duodenal ulcers is essential for guiding treatment decisions and assessing the effectiveness of therapeutic interventions. By identifying the current phase of the ulcer, healthcare providers can tailor medication plans, monitor healing progress, and reduce the risk of recurrence. Moreover, this classification system supports long-term patient management and contributes to better clinical outcomes.