Definition

A duodenal ulcer is an ulcer that forms on the inner wall of the duodenum, typically caused by infection with Helicobacter pylori bacteria. The spread of this ulcerative condition often depends on the spread of this bacterium. Duodenal ulcers are a type of peptic ulcer that can occur in both the stomach and the small intestine. Peptic ulcers, specifically in the stomach, are often called gastric ulcers.

Causes

Ulcers in the small intestine develop when stomach acid comes into contact with the intestinal wall. A protective mucous layer shields the small intestine from this acidic fluid. However, infection with the bacterium Helicobacter pylori can thin this mucosal layer, irritating the intestinal cells and allowing stomach acid to damage the lining directly. Additionally, long-term use of certain pain-relieving medications, such as ibuprofen and mefenamic acid, can contribute to thinning the mucosal layer. These medications reduce the production of prostaglandins, which normally protect the stomach and small intestine lining from acid. It is important to note that pain relievers like paracetamol (acetaminophen) do not have this effect.

Risk Factors

The risk factors for duodenal ulcers encompass a range of causes, including gastric ulcers, evidence of Helicobacter pylori infection, and long-term use of pain relievers. Additionally, conditions that cause thinning of the mucosal layer, such as malignancy, vascular abnormalities, and a history of chemotherapy, can contribute to the development of duodenal ulcers. Lifestyle factors like smoking and alcohol consumption also heighten the risk. Furthermore, long-term treatment with aspirin and clopidogrel, commonly prescribed for individuals with a history of coronary heart disease and stroke, can increase susceptibility to duodenal ulcers

Symptoms

The symptoms of a duodenal ulcer often include upper abdominal pain described as burning or gnawing, feelings of fullness, nausea, bloating, and difficulty digesting fatty foods, leading to frequent bloating or belching with an odor. Typically, pain associated with a duodenal ulcer improves after eating, leading to increased food intake as a means of alleviating symptoms and potentially resulting in weight gain. Additionally, dark or black stool may indicate gastrointestinal bleeding, and in severe cases, blood may be vomited due to bleeding in the upper gastrointestinal tract.

Diagnosis

In cases where a duodenal ulcer is suspected, diagnostic examinations are performed to localize abdominal pain and assess for signs of anemia, such as pale skin and pallor of the inner eyelids. Laboratory tests may include a complete blood count to evaluate hemoglobin levels, with additional blood typing and crossmatching tests if severe anemia necessitates a blood transfusion. Additionally, a blood urea test can detect elevated urea levels indicative of Helicobacter pylori infection, while a urea breath test may be employed to identify urea products associated with this infection. Fecal occult blood testing may be conducted to detect blood in stool samples.

Ultrasonography (USG) may be performed initially to visualize the ulcer, particularly in cases of upper gastrointestinal bleeding presenting with symptoms such as blood in vomit or dark stools. Endoscopy, if available, offers a more detailed examination by inserting a specialized tube with a camera through the mouth, allowing visualization of the esophagus, stomach, and small intestine. During endoscopy, tissue samples can be collected for microscopic examination to confirm the presence of Helicobacter pylori infection and other pathological findings.

Management

The treatment of duodenal ulcers is tailored to the patient's specific condition, with priority given to stabilizing those presenting with gastrointestinal bleeding or perforation. Initial management involves administering intravenous fluids to maintain blood volume and stabilize the patient's condition. Patients with severe bleeding or perforation often require surgical intervention to stop the bleeding and repair the perforation. After acute stabilization, ongoing monitoring of the ulcer's status through endoscopy is necessary, typically over a period of 2-3 months.

For patients with a history of prolonged painkiller use, cessation of these medications is recommended to prevent exacerbation of the condition. Similarly, individuals who smoke or regularly consume alcohol should discontinue these habits to minimize symptom aggravation, as smoking and alcohol consumption can exacerbate ulcer symptoms.

Medical therapy to reduce stomach acid production is a cornerstone of ulcer management. The duration of medication depends on symptom severity, patient compliance, and the risk of ulcer recurrence. In cases where Helicobacter pylori infection is identified as the underlying cause, antibiotic therapy is prescribed to eradicate the bacteria and reduce the risk of ulcer recurrence.

Complications

The primary complications of duodenal ulcers include bleeding, intestinal perforation, and gastric outlet obstruction. Management of bleeding ulcers often involves a combination of medications and endoscopic procedures. Endoscopy allows for interventions such as thermal coagulation, clipping of bleeding vessels, or local injection of medications near the ulcer site. If endoscopic therapy fails or is not feasible, particularly in critical conditions or with large ulcers, surgical intervention may be necessary.

Intestinal perforation, characterized by severe abdominal pain typically starting in the upper middle abdomen and spreading, requires prompt surgical repair to close the perforation. Antibiotics are administered to prevent infection within the abdominal cavity. Gastric outlet obstruction, although less common, can occur as a complication of duodenal ulcers.

Prevention

Prevention of duodenal ulcers primarily involves measures to prevent Helicobacter pylori infection, which is suspected to spread through contact with other people or contaminated food and beverages. Practicing good hand hygiene by washing hands before meals and consuming thoroughly cooked food can help reduce the risk of infection.

When prescribed pain relief therapy by a doctor, it's advisable to take medications with food and at the lowest effective dose. Avoiding alcohol consumption during treatment is also recommended. Additionally, it's important not to self-medicate with pain relievers without a doctor's prescription.

When to see a doctor?

If you or someone you know experiences symptoms such as vomiting blood or passing black stool, it's crucial to seek medical help promptly. Continuous blood vomiting accompanied by difficulty breathing requires immediate attention, as there's a risk of blood entering the respiratory tract. Additionally, symptoms like fatigue or severe abdominal pain that improves after eating should not be ignored and warrant consultation with a doctor, as they may indicate the presence of duodenal ulcers or other gastrointestinal bleeding.

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