Duodenal ulcer
A duodenal ulcer is a type of peptic ulcer found in the duodenum, the initial segment of the small intestine connected to the stomach. It manifests as a sore on the duodenum's lining and is most commonly caused by an infection with the bacterium Helicobacter pylori. In addition to H. pylori, the use of nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin and ibuprofen can also lead to the development of these ulcers. Symptoms typically include abdominal discomfort, which may present as a dull or burning pain, particularly when the stomach is empty. Other signs can include weight loss, nausea, and bloating, while severe cases may cause sharp pain or blood in vomit or stools, necessitating immediate medical attention.
Diagnosis usually involves a review of medication history and testing for H. pylori, utilizing methods like breath or stool tests, and sometimes endoscopy for direct visualization. Treatment primarily focuses on stopping NSAID use and employing acid-reducing medications. For ulcers caused by H. pylori, a course of antibiotics is required. Preventative measures include practicing good hygiene, careful food preparation, and judicious use of NSAIDs. Understanding these aspects can help individuals recognize the condition and seek appropriate care.
Duodenal ulcer
- ANATOMY OR SYSTEM AFFECTED:Abdomen,digestive system, gastrointestinal system,intestines,stomach
- ALSO KNOWN AS: Peptic ulcer, ulcer
Definition
A duodenal ulcer is a peptic ulcer that is located in the duodenum, the upper part of the small intestine where it attaches to the stomach. The ulcer is a sore on the lining of the duodenum.
Causes
More than one-half of the cases of duodenal ulcer are caused by infection with a bacterium called Helicobacter pylori (H. pylori). Aspirin and ibuprofen are examples of nonsteroidal anti-inflammatory drugs (NSAIDs) that can also cause duodenal ulcers. Rarely, tumors that are benign (not cancerous) or malignant (cancerous) may cause ulcers. Eating spicy foods, stress, smoking, and drinking alcohol do not cause, but do often worsen the symptoms of, ulcers.
Risk Factors
Infection with H. pylori is common. Infections can develop in childhood without causing symptoms until later in life. Drinking contaminated water or eating contaminated food increases the risk of taking in the bacterium. Food that is not properly washed or cooked increases the chance of infection. Contact with the saliva, vomit, or feces of an infected person may also transfer the bacterium.
Symptoms
Discomfort in the abdomen is the most common symptom, but some people have no symptoms or mild symptoms only. Discomfort may be a dull or burning pain (heartburn) that lasts a few minutes or hours when the stomach is empty, and episodes may continue for days or weeks. Discomfort may improve after eating or taking antacids. Weight loss, lack of appetite, burping, bloating, nausea, and vomiting are all common symptoms. If sharp, persistent, and severe pain or bloody vomit or bowel movements occur, one should consult a doctor immediately.
Screening and Diagnosis
A physician usually makes the diagnosis by taking a careful history of drugs used, especially prescription or over-the-counter NSAIDs, and by testing for H. pylori. A breath test or stool test is more accurate at finding H. pylori than are blood tests. If symptoms are severe, a thin, lighted tube with a camera on the end (endoscope) is threaded down the throat and through the stomach to the duodenum to look at the area (endoscopy). Radiology (X-ray) tests of the upper gastrointestinal tract may also be done.
Treatment and Therapy
The primary treatment for NSAID-related duodenal ulcers is stopping the drug and using medicines that reduce stomach acid to decrease pain and promote healing and coat the ulcer to protect it from stomach acid. For duodenal ulcers caused by H. pylori, antibiotic therapy for ten to fourteen days usually heals the ulcer. Different antibiotic regimens are used throughout the world because the H. pylori bacterium has become resistant to some antibiotics. This means that the drug is no longer effective in killing the bacterium. Medicines to reduce acid and coat the ulcer are also used. About four weeks after treatment, the person is tested again to see if the H. pylori bacterium is gone.
Prevention and Outcomes
While it is not known how H. pylori spreads, the bacterium can be avoided with careful handwashing, especially after using the toilet and before eating, washing, and cooking food; drinking clean water; not sharing drinks and food with others; and using gloves when cleaning up vomit or bowel movements. Taking NSAIDs in recommended doses or only when needed may also prevent a duodenal ulcer.
Bibliography
Almadi, Majid A. et al. "Peptic Ulcer Disease." The Lancet, vol. 404, no. 10447, July 6, 2024, pp. 68-81, www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)00155-7/abstract. Accessed 3 Feb. 2025.
Feldman, Mark, Lawrence S. Friedman, and Lawrence J. Brandt, eds. Sleisenger and Fordtran’s Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. New ed. 2 vols. Philadelphia: Saunders/Elsevier, 2010.
Jewell, Tim. "What Is a Duodenal Ulcer?" Healthline, 3 Aug. 2023, www.healthline.com/health/duodenal-ulcer. Accessed 3 Feb. 2025.
Kapadia, Cyrus R., James M. Crawford, and Caroline Taylor. An Atlas of Gastroenterology: A Guide to Diagnosis and Differential Diagnosis. Boca Raton, Fla.: Pantheon, 2003.
Kirschner, Barbara S., and Dennis D. Black. “The Gastrointestinal Tract.” In Nelson Essentials of Pediatrics, edited by Karen J. Marcdante et al. 6th ed. Philadelphia: Saunders/Elsevier, 2011.
McColl, Kenneth E. L. “ Helicobacter pylori Infection.” New England Journal of Medicine 362 (2010): 1597-1604.