Duodenal Ulcer

Duodenal Ulcer

A duodenal ulcer (Ulcus duodeni) is damage to the inner wall of the intestine. In detail, there is a dripping and excessive gastric juice secretion that attacks the wall of the duodenum. In addition to smoking, stress and medication, the bacterium Helicobacter pylori can also be responsible for the disease of a duodenal ulcer.

What is a duodenal ulcer?

The duodenum is an approximately 30 cm long, C-shaped part of the intestine and is located between the exit from the stomach and the small intestine. The duodenal ulcer (Ulcus duodeni) is a deep substance defect in its wall. By definition, this defect extends deeper than the muscle layer lying beneath the mucosa. For hvs definition and meaning, please visit howsmb.com.

Ulcer is the most common disease of the duodenum and is about five times as common as gastric ulcer. If only the mucous membrane is affected, this is referred to as erosion. Up to two percent of all people develop a duodenal ulcer in the course of their lives, men significantly more often than women. The peak incidence is in middle age.

Causes

In order for a duodenal ulcer to develop, there must generally have been an imbalance between the mucosa-protecting and damaging factors. The most common cause is an infestation with a bacterium (Helicobacter Pylori), which can be detected in 90% of diagnosed duodenal ulcers. Through certain adaptation processes, eg the formation of neutralizing enzymes, this can not only survive in the acidic environment of the upper gastrointestinal tract, but also multiply.

Additional damaging factors are the use of certain medications (e.g. diclofenac and aspirin ), stress (physical and psychological) and circulatory disorders. A rare cause of a duodenal ulcer is a tumor disease in which the production of gastric acid is massively increased (by so-called gastrin-producing tumors). It has also been shown that people with blood group 0 are significantly more likely to develop a duodenal ulcer, the cause has not yet been fully clarified.

Symptoms, Ailments & Signs

Symptoms of a duodenal ulcer develop very slowly. Only over the course of weeks and months do they become more noticeable. Typical signs at the beginning of the disease can be a feeling of fullness and frequent flatulence. Heartburn and acid regurgitation can also appear as initial symptoms.

A small proportion of those affected by a duodenal ulcer feel no symptoms in this first phase. The other sufferers feel an increasing dull pain in the upper abdomen. The pain can radiate to the back. Likewise, nausea and vomiting or loss of appetite can be non-specific signs of a duodenal ulcer.

This can lead to an aversion to certain foods. Over time, unnatural weight loss can occur. A more classic symptom is when the pain occurs regularly on an empty stomach. This can definitely be at night. Eating food usually improves the symptoms.

About one in five duodenal ulcers is associated with bleeding, which is excreted in the stool or when you vomit and thus become visible. Due to the mixing of blood and gastric acid, the stool has a characteristic black coloration (so-called tarry stool ). Depending on the extent of the blood loss, circulatory problems can also occur. In isolated cases, the ulcer can cause a life-threatening gastric perforation. This causes severe pain in the pit of the stomach.

Course of the disease

The symptoms of a duodenal ulcer are completely unspecific at the beginning of the disease, so the diagnosis is often made late. Typical complaints are loss of appetite (with an aversion to certain foods), nausea and pressure in the stomach area or a feeling of fullness in the upper middle abdomen. Unwanted weight loss and stool abnormalities can also occur.

If the duodenal ulcer starts to bleed, it is not uncommon for black-colored stool (so-called tarry stool ) to occur. This is because blood turns black when it comes into contact with aggressive stomach acid (formation of hematin). Tarry stool always requires clarification and should therefore give rise to further research into the cause. In the event of a sudden devastating pain, a perforation (this is a breakthrough of the duodenal ulcer into the free abdominal cavity) must be feared.

Not infrequently, however, the patients are completely asymptomatic and the diagnosis is made by chance. The diagnosis of a duodenal ulcer is made via a gastroscopy (gastroscopy). As part of the examination, a rapid test for the typical germ Helicobacter Pylori is always carried out. In addition, a small piece of tissue is sent in, which enables reliable detection or exclusion of an infestation with the harmful bacterium.

Complications

Bleeding is one of the most common complications of a duodenal ulcer. Older people are particularly at risk. Long-term use of certain painkillers can also cause bleeding, particularly in larger ulcers. Minor bleeding often goes unnoticed, but can cause anemia: This is often discovered by chance during a routine check-up.

Black stool, also known as tarry stool, can indicate a bleeding ulcer. If larger vessels are affected, bleeding from an ulcer often takes a highly dramatic course: due to massive blood loss in a short period of time, there is a risk of life-threatening shock if the bleeding cannot be stopped by immediate surgery.

Another dreaded complication is the perforation of a duodenal ulcer into the abdominal cavity: the escaping stomach contents can cause life-threatening peritonitis, so immediate emergency surgery is unavoidable. Depending on the location of the ulcer, it can also penetrate the surrounding organs – such as the pancreas or the large intestine – and cause damage there.

If the ulcer is close to the outlet of the stomach, it is not uncommon for a narrowing to occur, which hinders the further transport of the chyme: constant vomiting and massive weight loss can be the result. In very rare cases, a duodenal ulcer can degenerate malignantly and later on form secondary tumors in other organs.

When should you go to the doctor?

If the person concerned suffers from unpleasant flatulence, a feeling of pressure in the abdomen or pain in the lower abdomen, a doctor’s visit is necessary. If there is a steady increase in health problems over a period of days, weeks or months, a doctor is needed. Swelling, a general feeling of being unwell or a decrease in physical capacity are among the health irregularities that can occur. Nausea, vomiting and loss of appetite are further indications of an existing disease.

The complaints must be checked by a doctor so that a diagnosis can be made. A decrease in body weight, a feeling of internal dryness, and an inner restlessness should be presented to a doctor. Abnormalities when going to the toilet and bad breath are also among the health disorders that can be triggered by a duodenal ulcer. Behavior changes, emotional irregularities, and digestive disturbances need to be discussed with a doctor.

The person concerned requires medical tests so that a diagnosis can be made. If left untreated, the existing ulcer will continue to grow and can lead to numerous complications and further deterioration in health. Bleeding in the stool or discoloration of the stool is cause for concern. If these peculiarities occur, there is an immediate need for action. A doctor’s visit is necessary so that treatment can be initiated and the symptoms alleviated.

Treatment & Therapy

The basic therapy in the therapy of a duodenal ulcer consists of an effective acid inhibition. In this way, an attempt is made to restore the disturbed balance between mucosal damage and protection. Drugs from the active substance group of proton pump inhibitors are usually used, such as Pantozol or Omeprazol. In many studies, these show the strongest acid protection with comparatively few side effects.

Since the cause is usually an infection with Helicobacter Pylori, the therapy is supplemented by two antibiotics (triple therapy) after the bacterium has been detected. Clarithromycin is standard, but amoxicillin or, alternatively, metronidazole is also used. Today, surgical therapy is usually only necessary in the case of complications. As a rule, parts of the stomach are completely removed.

Typical indications are uncontrollable bleeding, perforation of the duodenal ulcer or suspected malignant tumor. Even if acid production cannot be reduced effectively with medication, surgical treatment can be performed by severing a nerve cord that regulates acid production.

In addition, if you have a duodenal ulcer, you should avoid nicotine and alcohol, as well as spicy foods. Stress reduction and a sporty, healthy lifestyle should also be aimed for.

Aftercare

In most cases, those affected with a duodenal ulcer have only very few and only very limited aftercare measures available, so that the person affected with this disease should ideally consult a doctor at an early stage and also initiate treatment. The sooner a doctor is consulted for a duodenal ulcer, the better the further course of this disease is usually.

Most of those affected are dependent on taking various medications that can alleviate and limit the symptoms. The choice of medication depends heavily on the cause of the disease. In general, the person concerned should ensure that they take the medication regularly and also take the correct dosage. If anything is unclear or if you have any questions, consult a doctor first to avoid other symptoms or complications.

When taking antibiotics, it should also be noted that they should not be taken together with alcohol. In general, it is also advisable to follow a healthy lifestyle with a balanced diet if you have a duodenal ulcer. Alcohol and nicotine should be avoided if possible. In some cases, the disease itself can reduce the life expectancy of those affected.

You can do that yourself

Duodenal ulcer A duodenal ulcer always requires medical treatment. Rapid improvement is usually achieved with the highly effective medication, but various self-help measures can support the healing process. They also help prevent ulcers from coming back.

Consistent avoidance of triggers is particularly important. This not only applies to the acute phase of the disease, but also afterwards. The typical triggers of a duodenal ulcer include primarily alcohol, tobacco products, milk and sugary foods. Spices such as mustard, pepper and horseradish can also have a stimulating effect on acid formation. Certain medications, such as acetylsalicylic acid, which are not always necessary, are also problematic.

Diets that protect the mucous membrane, such as a tea and rusk diet for 24 to 36 hours, are recommended. After that, the patient gradually returns to his usual diet. In the first two days, a light diet of potatoes and cooked vegetables makes sense. From the third day, you can eat low-fat meat dishes again. It is also helpful to eat several small meals a day instead of just a few large menus.

Another self-help option is offered by relaxation methods such as meditation or autogenic training. They are particularly effective against stress-related complaints. In addition, alternative treatment methods such as acupuncture or the intake of homeopathic remedies such as Acidum sulfuricum, Nux vomica, Belladonna or Acidum muriaticum can also be used.

Duodenal Ulcer