A duodenal ulcer often occurs in the first part of the duodenum. It is a manifestation of peptic ulcer disease, characterized by damage and ulceration of the mucosal lining of the upper gastrointestinal tract due to an imbalance between damaging factors and protective mechanisms of the mucosa.

Symptoms of Duodenal Ulcer

The primary symptom of a duodenal ulcer is episodes of upper abdominal pain, described as sharp and worsening with hunger. The pain often subsides after eating or with the use of antacid medications. The symptoms can be categorized as follows:

1. Common Symptoms

Burning stomach pain.

Feeling of fullness, bloating, or belching.

Intolerance to fatty foods.

Heartburn.

Nausea.

2. Less Common Symptoms

Vomiting, sometimes with blood that may appear red or black.

Dark blood in stools or black, tarry stools.

Difficulty breathing.

Fainting.

Unexplained weight loss.

Changes in appetite.

Causes and Risk Factors of Duodenal Ulcer

1. Causes of Duodenal Ulcer

Bacteria: Helicobacter pylori bacteria often inhabit the mucosal layer protecting the stomach and small intestine lining. While typically harmless, these bacteria can sometimes inflame the stomach's inner layer, leading to ulcer formation.

The exact mode of transmission of H. pylori is unclear, but it may spread through close contact, such as kissing, or via contaminated food and water.

Prolonged Use of Pain Relievers: Regular use of aspirin or other over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) can irritate or inflame the stomach and intestinal lining.

2. Risk Factors for Duodenal Ulcer

Smoking.

Alcohol consumption.

Untreated hypertension.

Consumption of spicy foods.

Complications of Duodenal Ulcer

Complications may include:

1. Internal Bleeding

This can range from slow blood loss, leading to anemia, to severe blood loss requiring hospitalization or blood transfusion. Severe bleeding may present as black or bloody stools or black, bloody vomit.

2. Perforation of the Stomach Wall

Peptic ulcers can erode through the stomach or duodenal wall, increasing the risk of severe abdominal infection.

3. Digestive Tract Obstruction

Ulcers can block the passage of food through the digestive tract due to swelling, inflammation, or scar tissue, causing early satiety, vomiting, and weight loss.

4. Stomach Cancer

Studies have shown that individuals with H. pylori infection are at a higher risk of developing stomach cancer.

Diagnosis of Duodenal Ulcer

The diagnostic methods include:

1. Upper Gastrointestinal Endoscopy

A flexible tube with a tiny camera is inserted into the esophagus, stomach, and duodenum to visually inspect the mucosal lining and collect tissue samples to detect H. pylori infection or malignancies. This procedure may also allow for therapeutic interventions such as removing tumors or cauterizing bleeding vessels.

2. X-ray Imaging of the Stomach and Duodenum

While this method is less precise and detects only about 70% of ulcer cases, it can identify structural abnormalities. Unlike endoscopy, it does not allow for biopsies or H. pylori testing.

If no symptoms of malignancy are present, a non-invasive test to detect H. pylori infection is recommended. Treating H. pylori effectively cures the ulcer. If no evidence of H. pylori infection is found, the likelihood of an ulcer is very low, and symptomatic treatment can suffice.

Treatment of Duodenal Ulcer

Treatment options include:

1. Antibiotics

If H. pylori is detected, a combination of antibiotics is prescribed to eradicate the bacteria. The choice of antibiotics depends on local resistance patterns, and treatment usually lasts for two weeks, alongside medications to reduce stomach acid.

2. Acid-Blocking Medications

Proton pump inhibitors (PPIs) reduce acid production by inhibiting gastric acid-producing cells. However, long-term use of PPIs, especially at high doses, may increase the risk of hip, wrist, or spine fractures.

3. Medications to Decrease Acid Production

Histamine (H2) blockers reduce the amount of acid released into the digestive tract, alleviating ulcer pain and promoting healing.

4. Antacids

Your doctor may include antacids in your treatment plan. These neutralize existing stomach acid, providing rapid pain relief, although their effects are temporary. Side effects may include constipation or diarrhea, depending on the primary ingredients. Antacids are generally not used as the sole treatment for ulcers.

Prevention of Duodenal Ulcer

1. Protect Yourself from Infections

While the transmission route of H. pylori is unclear, evidence suggests it spreads through person-to-person contact or contaminated food and water. Preventive measures include frequent handwashing with soap and water and consuming thoroughly cooked foods.

2. Use Pain Relievers with Caution

If you frequently use pain relievers that increase ulcer risk, take steps to reduce the likelihood of gastrointestinal complications. For example, take medications with food to minimize irritation.