Which type of ulcer always requires biopsy and endoscopic monitoring to rule out malignancy?

Gastric ulcers always require biopsy and endoscopic monitoring because there is a significant risk of malignancy associated with them. The potential for gastric cancer necessitates this careful approach to rule out any malignant transformation. Unlike duodenal ulcers, which are usually benign and less likely to be associated with cancer, gastric ulcers may present with features that could indicate a cancerous process, such as irregular or raised edges.

Endoscopic examination allows for direct visualization and biopsy of the ulcer, which can provide histological evidence to confirm whether malignancy is present. This proactive measure is crucial in the management of patients with gastric ulcers, particularly in those over a certain age or those with concerning symptoms. It ensures that any potentially dangerous conditions are identified and treated promptly.

While peptic ulcers encompass gastric and duodenal ulcers, the specific requirement for biopsy and close monitoring is particularly applicable to gastric ulcers due to the cancer risk. Esophageal ulcers, although they can also be serious, usually have different underlying causes and management strategies that do not necessitate the same routine biopsying as gastric ulcers.