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Duodenal Ulcer - Causes, Risk Factors, Symptoms, Diagnosis, Treatment, Complications, and Prevention

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Duodenal ulcers are sores that develop on the duodenum (upper part of the small intestine). Read the article below to learn more about duodenal ulcers.

Written by

Dr. P. Saranya

Medically reviewed by

Dr. Jagdish Singh

Published At September 6, 2022
Reviewed AtJune 11, 2024

Introduction:

Peptic ulcers are sores that develop on the stomach lining and the upper part of the small intestine (duodenum). Peptic ulcers include gastric and duodenal ulcers. Gastric ulcers are ulcers that occur on the stomach, and duodenal ulcers are ulcers that appear on the duodenum (upper portion of the small intestine).

What Causes Duodenal Ulcers?

Ulcers are formed when the acid in the digestive tract eats the inner surface of the stomach or small intestine. The acid creates a painful sore that may bleed. The digestive tract is usually coated with a mucous layer that protects against stomach acid. Ulcers are formed if the amount of acid is increased or mucus is decreased.

The following can cause gastric and duodenal ulcers:

  • Bacterium: Helicobacter pylori is a bacteria that usually lives in the mucus layer that lines the stomach and small intestine. Usually, the bacteria do not cause any problems, but sometimes, they can cause inflammation of the stomach’s inner lining, producing an ulcer.

  • Pain Killers: Regular use of certain painkillers such as non-steroidal anti-inflammatory drugs (NSAIDs) can cause inflammation of the stomach and small intestine lining. The medications include Ibuprofen, Naproxen sodium, and Ketoprofen.

  • Other Medications: Certain medications such as steroids, anticoagulants, and low-dose Aspirin, when taken along with non-steroidal anti-inflammatory drugs (NSAIDs), can cause ulcers.

The pathophysiology of duodenal ulcers is that these ulcers occur when there is a disruption of the mucosa surface present in the duodenum. This is a peptic ulcer condition involving the stomach and the first region of the duodenum.

What Are the Risk Factors for Duodenal Ulcers?

The risk factors for ulcers include:

  • Smoking: Smoking increases the risk of ulcers in people infected with Helicobacter pylori.

  • Alcohol: Drinking excessive alcohol can irritate the mucous lining of the stomach.

  • Stress and Spicy Foods: Being stressed and taking more spicy foods can also increase the risk of ulcers.

What Are the Symptoms of Duodenal Ulcers?

Many people do not show any symptoms. However, if symptomatic, the most common symptom is burning stomach pain. Stomach acid and an empty stomach make the pain worse. The pain is worse at night and between meals.

The other symptoms include

  • The feeling of fullness.

  • Bloating or belching.

  • Nausea.

  • Heartburn.

  • Intolerance to fatty foods.

Some rare severe signs and symptoms of ulcers include:

  • Vomiting or blood vomiting.

  • Trouble breathing.

  • Unexplained weight loss.

  • Appetite changes.

  • Giddiness.

How Can One Diagnose Ulcers?

A complete medical history is taken, and a physical examination is done. In addition, the following tests are done to confirm the diagnosis:

  • Tests for Helicobacter Pylori: The doctor performs blood, stool, or breath tests to look for the Helicobacter pylori bacterium. The breath test is the most accurate.

  • Endoscopy: It is a procedure done to examine the upper digestive tract. During an endoscopy, the doctor inserts a thin, hollow tube with a camera into the throat, esophagus, stomach, and small intestine. The doctor looks for ulcers, and if ulcers are present, a tissue sample is taken for analysis in the laboratory. Endoscopy is recommended in older patients with signs of bleeding, recent weight loss, or difficulty eating and swallowing.

  • Barium Swallow: The patient drinks a liquid containing barium that coats the digestive tract lining, and a series of X-rays are taken to make ulcers more visible.

How to Treat Duodenal Ulcers?

Treatment depends on the cause. It involves killing the Helicobacter pylori bacteria, reducing the use of NSAIDs, and healing the ulcer with medication.

Medications include:

  • Antibiotics: A combination of antibiotics is given to kill Helicobacter pylori. These include Amoxicillin, Clarithromycin, Metronidazole, Tinidazole, Tetracycline, and Levofloxacin.

  • Proton Pump Inhibitors: These medications block acid production. The medications include Omeprazole, Lansoprazole, Rabeprazole, Esomeprazole and Pantoprazole.

  • H2 Receptor Blockers: These medications reduce the amount of stomach acid released into the digestive tract. Drugs include Famotidine, Cimetidine, and Nizatidine.

  • Antacids: Antacids neutralize stomach acid and provide rapid relief.

  • Cytoprotective Agents: These medications protect the stomach and small intestine lining. Drugs include Sucralfate and Misoprostol.

Treatment is usually successful, resulting in the healing of ulcers. However, the doctor recommends a follow-up endoscopy sometimes to see whether the ulcer is completely healed.

What Are the Complications of Duodenal Ulcers?

If untreated, ulcers can result in:

  • Internal Bleeding: Bleeding can result in slow blood loss, which results in anemia or severe blood loss that causes bloody vomit or black or bloody stools.

  • Perforation: Ulcers can perforate the stomach or small intestine wall, resulting in severe abdominal cavity infection (pericoronitis).

  • Obstruction: Ulcers can sometimes block the passage of food through the digestive tract resulting in the fullness of the stomach.

  • Gastric Cancer: People infected with Helicobacter pylori have an increased risk of gastric cancer.

What Are Refractory Ulcers?

The ulcers which do not heal with treatment are called refractory ulcers. The causes of refractory ulcers include:

  • Not taking the prescribed medications.

  • Regular use of tobacco.

  • Regular use of non-steroidal anti-inflammatory drugs (NSAIDs).

  • Some Helicobacter pylori become resistant to antibiotics.

Treatment of refractory ulcers involves eliminating the factors that interfere with healing.

How Can One Prevent Ulcers?

  • Protection Against Infections: Studies show that Helicobacter pylori infection can be transmitted from person to person through food and water. Frequently washing hands with soap and water and eating well-cooked foods can prevent the spread of these infections.

  • Cautious Use of Painkillers: If a person regularly takes painkillers, take additional medications such as an Antacid, proton pump inhibitor, or an acid blocker. Take medicine with meals and avoid alcohol consumption while taking non-steroidal anti-inflammatory drugs (NSAIDs), as both combine to increase the severity of ulcers.

What Are the Lifestyle and Home Remedies for Duodenal Ulcers?

  • Switching Pain Killers: Ask the doctor whether Acetaminophen can be used as an alternative to non-steroidal anti-inflammatory drugs (NSAIDs).

  • Control Stress: Stress can worsen the signs and symptoms of ulcers. Try some techniques to cope with stress like exercise, reading, or spending time with friends.

  • Avoid Smoking: Smoking can worsen the ulcer and also increase stomach acid.

  • Avoid Alcohol: Excessive alcohol use can irritate the mucosal lining of the digestive tract.

What Is the Prognosis?

In most of the cases, medications can heal ulcers. If H.pylori bacteria is eliminated then most forms of the ulcer do not reoccur. In some rare cases, surgery will be required if the medication does not help.

Conclusion:

Duodenal ulcers are a part of peptic ulcers that occur due to disruption of the mucosa of the duodenum. If diagnosed and treated correctly, duodenal ulcers have a good prognosis. In addition, duodenal ulcers are not usually associated with cancer.

Frequently Asked Questions

1.

Who Is Most Prone to Ulcers?

Ulcer risk factors include the following:
  - Smoking: Individuals with helicobacter pylori infection are more likely to get ulcers if they smoke.
- Alcohol: Drinking too much alcohol might irritate the stomach's mucous lining.
The risk of ulcers can also be increased by stress and spicy foods.
 

2.

Are Ulcers a Result of Coffee and Spicy Food?

A higher incidence of ulcers is also associated with coffee and spicy foods. A number of illnesses, including peptic ulcer and gastroesophageal reflux disease (GERD), two of the most prevalent esophageal-gastro-duodenal disorders worldwide, have been linked to coffee drinking. Duodenal and stomach ulcers make up peptic ulcers.

3.

Do Duodenal Ulcers Lead to Cancer?

In patients with antral gastritis linked to duodenal ulcers, pylori may cause the formation of corpus gastritis. As a result, middle-aged and elderly patients with duodenal ulcers frequently have gastritis in the corpus, which may put a patient at a high risk of developing stomach cancer.

4.

Which Duodenal Ulcer Symptom Is Most Reliable?

The most frequent symptom is burning stomach discomfort. The pain is exacerbated by stomach acid and an empty stomach. The discomfort is greatest at night and after meals. Some of the symptoms are
- Belly bloat or belching.
- Nausea.
- Heartburn.
- Sensitivity to fatty foods.
- Fullness

5.

Does a Duodenal Ulcer Pose a Life Threat?

Ulcers develop when the protective mucous lining of the stomach and duodenum has been worn away, allowing gastric acids and digestive enzymes to eat away the stomach and duodenal walls. This eventually leads to open sores that are constantly inflamed by the acid. They may develop major consequences, such as internal bleeding if left untreated. They may even develop a hole that is completely worn through over time. This results in a potentially fatal situation.

6.

What Results From Not Treating a Duodenal Ulcer?

Internal bleeding may occur as a result of untreated duodenal ulcers. Blood loss can be gradual and cause anemia or severe and necessitate hospitalization or blood transfusions.

7.

Is a Duodenal Ulcer Treatable?

Depending on the cause, different treatments are used. It entails eliminating the helicobacter pylori bugs, limiting NSAID use, and treating the ulcer with medicine
- Helicobacter pylori are killed by administering a mixture of antibiotics. Amoxicillin, Clarithromycin, Metronidazole, Tinidazole, Tetracycline, and Levofloxacin are a few of them.
- Drugs called proton pump inhibitors are used to prevent the generation of acid. Omeprazole, Lansoprazole, Rabeprazole, Esomeprazole, and Pantoprazole are a few of them.
- H2 Receptor Blockers: These drugs limit the flow of stomach acid into the digestive system. These medications include Nizatidine, Cimetidine, and Famotidine.
- Antacids quickly relieve pain by neutralizing stomach acid
- Cytoprotective agents are the drugs that shield the lining of the stomach and small intestine. Misoprostol and Sucralfate are examples of drugs.

8.

How Is a Duodenal Ulcer Diagnosed?

A thorough medical history is obtained, along with a physical examination. To confirm the diagnosis, the following tests are also performed:
- The doctor will do blood, stool, or breath tests to check for the presence of the Helicobacter pylori bacterium. The most accurate test is the breathalyzer.
- Endoscopy: This treatment allows a closer look at the upper digestive tract. During an endoscopy, the physician inserts a narrow, hollow tube with a camera into the stomach, small intestine, esophagus, and throat. A tissue sample is obtained for laboratory evaluation if the doctor finds any ulcers. Endoscopy is advised for elderly individuals who exhibit bleeding symptoms, have lost weight recently, or have trouble swallowing and eating.
- Barium Swallow: A series of X-rays are taken after the patient consumes a liquid containing barium to cover the lining of their digestive tract, making ulcers more noticeable.

9.

Do Duodenal Ulcers Require Surgery?

The most effective treatment for perforated duodenal ulcers is closure, followed by permanent ulcer surgery, such as vagotomy-pyloroplasty. The recommended course of action for perforated stomach ulcers is resection, although they may sometimes only be closed.

10.

How Long Does It Take for Duodenal Ulcers to Heal?

 
Duodenal ulcers frequently bring on abdominal pain. After receiving treatment, patients often recover in a few weeks. The cause of the duodenal ulcer will determine the prognosis; removing the cause will improve the prognosis.

11.

Is Stress a Cause of Duodenal Ulcers?

Stress, depression, and anxiety are examples of psychosocial factors that have been linked to slowed healing of duodenal ulcers. This shows that these variables may impact the biological processes (such as blood flow and gastric acid secretion) that may affect the formation of duodenal ulcers. Regardless of H. pylori infection or NSAID use, psychological stress enhanced the prevalence of duodenal ulcers.

12.

Can a Duodenal Ulcer Rupture?

Yes. So, if left untreated it will burn through the stomach wall, enabling food and digestive juices to flow into the abdominal cavity. An ulcer that has ruptured is referred to as a perforated duodenal ulcer. Surgery is typically required for treatment.

13.

Do Duodenal Ulcers Result From GERD?

When there is too much acid in the stomach, ulcers form. When the acid is in the wrong area, GERD (gastro-oesophageal reflux disease) develops. Even though these disorders cannot cause one another directly, it is helpful to remember that some causes and risk factors are related. For instance, using NSAIDs frequently can raise the risk of developing both illnesses.

14.

How Do Patients Manage a Duodenal Ulcer?

Numerous substances like NSAIDS, alcohol, and smoking, gastric secretions from the stomach corrode the surface epithelium of the small intestine, cause duodenal ulcers. Adopting a healthy lifestyle, getting an early diagnosis, and receiving timely treatment all aid in recovering from the condition by avoiding the stated causal cause.

15.

Does Eating Make Duodenal Ulcers Worse?

After eating, the pain from duodenal ulcers lessens. Although some meals and drinks can irritate one’s stomach, no solid proof exists that they cause or worsen ulcers. Even so, consuming a nutritious diet of fiber, fruits, and vegetables may lower the risk of developing ulcers.

16.

Does Fasting Help Duodenal Ulcers?

The suboptimal clinical response of some duodenal ulcer patients may be caused by food-induced interference with the therapeutic control of gastric output provided by H2-receptor antagonists. Long-term fasting can help with gastric secretion control and may help cure ulcers that are resistant to treatment.
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Dr. Jagdish Singh
Dr. Jagdish Singh

Medical Gastroenterology

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