What is a duodenal ulcer?
A duodenal ulcer is a sore that forms in the lining of the duodenum. Your duodenum is the first part of your small intestine, the part of your digestive system that food travels through straight after it leaves your stomach.
You can get an ulcer in your stomach as well as in your duodenum. Stomach ulcers and duodenal ulcers are both types of peptic ulcers. If you have either of these, you have what’s called ‘peptic ulcer disease’.
Causes of duodenal ulcers.
Your stomach makes a strong acid that kills germs and helps you digest food. To protect themselves against this acid, cells of the stomach and duodenum make a barrier from mucus. If this barrier is damaged, an ulcer can form.
The main cause of this damage is infection with bacteria called Helicobacter pylori, or H. pylori. The bacteria can cause the lining of your duodenum to become inflamed and an ulcer can form.
Some medications can also cause a duodenal ulcer, particularly anti-inflammatory drugs such as ibuprofen and aspirin. Rarely, other medicines or medical conditions might cause an ulcer.It’s possible that you are more likely to get a duodenal ulcer if you smoke, drink a lot of alcohol or you are stressed, but these things are less important than infection with H. pylori.
Symptoms of a duodenal ulcer.
If you have a duodenal ulcer, you might:
▪️have pain in the stomach or abdomen (this might come and go and is relieved by eating or taking an antacid).
▪️ have indigestion.
▪️ feel very full and bloated after eating.
▪️ feel like you might vomit (nauseous).
▪️ lose weight.
Very occasionally, an ulcer can cause serious complications. Go to the emergency department if:
▪️you have a sharp pain in your stomach that doesn’t go away.
▪️ your vomit or stools (poo) look bloody or a black colour.
Diagnosis of a duodenal ulcer.
To diagnose a duodenal ulcer, your doctor will talk to you and examine you.
They will probably also run some tests, which could include:
▪️a gastroscopy (also called an endoscopy), where a specialist uses a thin, flexible tube with a camera on the end to look inside your stomach and duodenum.
▪️ a blood test, stool sample, or breath test to find out if you have a H. pylori in your systemIf you have a gastroscopy, the surgeon might take a sample of tissue (a biopsy) to test for H. pylori.
Treatment for a duodenal ulcer.
If your ulcer is caused by H pylori, the usual treatment is ‘triple therapy’. This involves taking 2 antibiotics to kill the bacteria, and a medicine to reduce the amount of acid made by your stomach.
If you don’t have an H. pylori infection, and you have been using anti-inflammatory drugs, you will need to stop taking them (if possible) and to start taking a drug to reduce acid production by your stomach.
Examples of antibiotic treatments include:
Other medications to treat a duodenal ulcer.
Medications such as proton pump inhibitors and histamine H2-receptor antagonists, which decrease the amount of acid in the stomach, can also be an effective treatment for duodenal ulcer.
Proton pump inhibitors that are effective in the treatment of duodenal ulcer include:
Histamine H2-receptor antagonists that are effective in the treatment of duodenal ulcer include:
If you have diarrhea and vomiting, fluid and electrolyte replenishment is also a component of successful treatment.
Taking antacids, drinking less alcohol, and quitting smoking if you smoke may also help.
The potential complications of a duodenal ulcer.
Possible complications of duodenal ulcer include:
▪️Perforated duodenal ulcer, which can lead to bleeding .
▪️Severe discomfort or pain .
▪️Spread of infection .
▪️ Obstruction. Peptic ulcers can block passage of food through the digestive tract, causing you to become full easily, to vomit and to lose weight either through swelling from inflammation or through scarring.
▪️ Gastric cancer. Studies have shown that people infected with H. pylori have an increased risk of gastric cancer.
Products containing bismuth may help with symptoms of a peptic ulcer. There is also some evidence that zinc can help heal ulcers. Mastic powder, the product of a type of evergreen shrub, may also help improve symptoms and speed healing of peptic ulcers.
While certain over-the-counter and alternative medications may be helpful, evidence on effectiveness is lacking. Therefore they are not recommended as the primary treatment for peptic ulcers.
Duodenal ulcer”, www.healthdirect.gov.au
القرحة الهضمية الأعراض و الأسباب /https://www.mayoclinic.org/ar/diseases-conditions/peptic-ulcer/symptoms-causes/syc-20354223
القرحة الهضمية التشخيص والعلاج /https://www.mayoclinic.org/ar/diseases-conditions/peptic-ulcer/diagnosis-treatment/drc-20354229