Duodenal ulcer and duodenal erosion — DVA SoP factors

Reasonable Hypothesis (RH) — Statement of Principles No. 49 of 2024

At least one of the following factors must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting duodenal ulcer and duodenal erosion or death from duodenal ulcer and duodenal erosion with the circumstances of a person's relevant service:

1. (1)
   being a prisoner of war before clinical onset or clinical worsening;
2. (2)
   having Helicobacter pylori infection of the duodenum at the time of clinical onset or clinical worsening;
3. (3)
   having an infection of the duodenal mucosa by one of the following organisms: (a) Anisakis simplex (causing anisakiasis); (b) cytomegalovirus; (c) herpes simplex virus; (d) fungi (such as Candida species or Histoplasma capsulatum); (e) Helicobacter heilmannii; (f) Mycobacterium tuberculosis; (g) Strongyloides stercoralis (causing strongyloidiasis); or (h) Treponema pallidum infection (causing syphilis); at the time of clinical onset or clinical worsening;
4. (4)
   having a critical illness or injury within the 30 days before clinical onset or clinical worsening;

   Note: critical illness or injury is defined in the Schedule 1 - Dictionary.

5. (5)
   undergoing a course of radiotherapy for cancer, where the stomach or duodenum was in the field of radiation, within the one year before clinical onset or clinical worsening;
6. (6)
   having received a cumulative equivalent dose of at least 10 sieverts of ionising radiation to the stomach or duodenum within the one year before clinical onset or clinical worsening;

   Note: cumulative equivalent dose is defined in the Schedule 1 - Dictionary.

7. (7)
   undergoing 90Yttrium microsphere therapy for primary and metastatic liver tumours, within the one year before clinical onset or clinical worsening;
8. (8)
   having contact with a nasogastric tube or other foreign objects or extraneous material at the site of the ulcer or erosion at the time of clinical onset or clinical worsening;
9. (9)
   having Roux-en-Y gastric bypass within the 5 years before clinical onset or clinical worsening of duodenal ulcer or duodenal erosion, where the ulcer or erosion occurred at the site of the surgical anastomosis;
10. (10)
    having a gastrin-secreting tumour at the time of clinical onset or clinical worsening;
11. (11)
    smoking at least 10 cigarettes per day, or the equivalent thereof in other tobacco products, for at least the 12 months before clinical onset or clinical worsening;
12. (12)
    being treated with a non-topical non-steroidal anti-inflammatory drug, or aspirin, at least every other day during a continuous period of at least 8 days, within the 3 months before clinical onset or clinical worsening;
13. (13)
    having a solid organ or bone marrow transplant before clinical onset or clinical worsening;
14. (14)
    being treated with an antineoplastic agent within the 3 months before clinical onset or clinical worsening;

    Note: antineoplastic agent is defined in the Schedule 1 - Dictionary.

15. (15)
    being treated with one of the following drugs or class of drugs within the 7 days before clinical onset or clinical worsening: (a) bisphosphonate, including alendronate; (b) chemotherapeutic agents delivered by hepatic arterial infusion; or (c) potassium chloride tablet (enteric coated or wax formulation);
16. (16)
    being treated with one of the following drugs or class of drugs for at least 2 weeks, within the 3 months before clinical onset; (a) clopidogrel; (b) glucocorticoid, excluding topical or inhaled; (c) deferasirox; (d) nicorandil; (e) paracetamol of more than 2 grams daily; or (f) selective serotonin re-uptake inhibitors;
17. (17)
    taking one of the following drugs or class of drugs for at least 2 weeks, within the 3 months before clinical worsening; (a) anticoagulants; (b) clopidogrel; (c) corticosteroids, excluding topical or inhaled; (d) lanthanum; (e) levodopa with benserazide or carbidopa; (f) methylnaltrexone; (g) nicotinic acid; (h) paracetamol of more than 2 grams daily; (i) pentoxifylline; (j) selective serotonin re-uptake inhibitors; (k) spironolactone; (l) tocilizumab; (m) tofacitinib; or (n) upadacitinib;
18. (18)
    experiencing one of the following category 1A stressors within the 3 months before clinical onset or clinical worsening: (a) experiencing a life-threatening event; (b) being subject to a serious physical attack or assault including rape and sexual molestation; or (c) being threatened with a weapon, being held captive, being kidnapped, or being tortured;
19. (19)
    having posttraumatic stress disorder within the 3 months before the clinical onset or clinical worsening;
20. (20)
    being diagnosed by a registered medical practitioner with anxiety disorder, depressive disorder, bipolar disorder, obsessive compulsive disorder or panic disorder at the time of clinical onset or clinical worsening;
21. (21)
    having cirrhosis of the liver at the time of clinical onset or clinical worsening;
22. (22)
    having alcohol use disorder or drinking at least 4 standard drinks per day for at least 6 months at the time of bleeding of a duodenal ulcer;

    Note: The bleeding of a duodenal ulcer is considered to be a clinical worsening.

    Note: Alcohol consumption is calculated utilising the Australian Standard of 10 grams of alcohol per standard alcoholic drink.

23. (23)
    having diabetes mellitus at the time of clinical onset or clinical worsening;
24. (24)
    having Crohn disease (a type of inflammatory bowel disease) at the time of clinical onset or clinical worsening;
25. (25)
    having one of the following medical conditions at the time of clinical onset or clinical worsening; (a) amyloidosis; (b) eosinophilic gastroenteritis; (c) sarcoidosis; (d) systemic mastocytosis; or (e) uraemic gastritis;

    Note: systemic mastocytosis is defined in the Schedule 1 - Dictionary.

    Note: Uraemic gastritis is a gastritis that occurs in the setting of poorly treated or untreated chronic renal failure.

26. (26)
    having chronic obstructive pulmonary disease at the time of bleeding of a duodenal ulcer;

    Note: The bleeding of a dudenal ulcer is considered to be a clinical worsening.

27. (27)
    inability to obtain appropriate clinical management for duodenal ulcer and duodenal erosion;