What is duodenal ulcer?
A duodenal ulcer is a benign lesion that manifests as deep and widespread damage to the wall of the duodenum. Duodenal ulcers are approximately four times more frequent than gastric ulcers.
The most common cause of a duodenal ulcer is a hypersecretion of gastric juice. There are other factors, such as certain medications, nicotine or stress which may favor the development of a duodenal ulcer. In addition, bacterial infections produced by Helicobacter pylori, for example, play a key role in the development of a duodenal ulcer.
Duodenal ulcer is the most common type of ulcer among persistent ulcer diseases. Its symptoms are not indicative and range from pain, pressure and feeling of heaviness in the epigastrium, to belching, gas, nausea or vomiting. First, a duodenal ulcer is treated with medications and by modifying lifestyles (for example, eating a healthy food for the stomach or avoiding stress). In the case of a duodenal ulcer, surgical operation may be an option if previous treatments are ineffective or complications arise.
The recovery rate of a duodenal ulcer is very positive, as long as the treatment is followed correctly. Some of the possible serious complications of duodenal ulcer are bleeding and perforation in the stomach cavity, which can lead to inflammation of the peritoneum (peritonitis).
What causes duodenal ulcer?
A duodenal ulcer can have several causes. Basically, it is considered that a high concentration of acids and enzymes in the gastric juice always represents a high risk for the mucosa of the stomach and the duodenum. An alkaline mucosa that neutralizes gastric acid and a high rate of blood flow, as well as the production of the so-called prostaglandin are part of the complex mechanisms of protection that normally prevent the deterioration of the duodenum.
The mucosa can resist the damage of gastric juice by forming secretin in the duodenum after food intake which inhibits the secretion of gastric juice. Any imbalance between the aggressive factors on the one hand and the protectors on the other hand results in a deterioration that may be the cause of a duodenal ulcer.
Hypersecretion of gastric juice
Among the possible causes of a duodenal ulcer, exaggerated secretion (hypersecretion) is the most important. Any hypersecretion (in quantity, amplitude or frequency) destroys the mucosa.
As a cause of a duodenal ulcer, certain bacteria must also be taken into account. Between 90 and 99% of all cases of duodenal ulcer the bacterium Helicobacter pylori is detected. Another indicator of the influence of bacteria on the appearance of ulcer is the fact that microbiological detection shows a reproductive ulcer (recurrence) in 80% of cases. In the case of duodenal ulcer patients which are not caused by a pathogen, the reproductive ulcer appears only in 10% of the cases.
A duodenal ulcer may also be caused by certain diseases. Zollinger-Ellison syndrome and hyperfunction of the parathyroid gland (hyperparathyroidism) may lead to the formation of a duodenal ulcer.
Both diseases are linked to hypersecretion of gastric juice: Zollinger-Ellison syndrome is caused by a tumor in the pancreas where the gastrin hormone is formed. Hyperparathyroidism causes an increase in the concentration of calcium in the blood, which results in the secretion of gastrin and thereby an indirect secretion of gastric acid. Among the possible causes of a duodenal ulcer hypersecretion of gastric juice is the most important.
In addition to the colonization of Helicobacter pylori bacteria and hypersecretion of gastric juice, there are other factors responsible for the development of a duodenal ulcer: Some drugs such as nonsteroidal anti-inflammatory drugs (NSAIDs, for example acetylsalicylic acid) and corticosteroids, such as cortisone which damage the gastric mucosa and cause the development of a stomach and duodenal ulcer. The intensity of its effect depends on the dose and the duration of the intake.
Duodenal ulcer can also have hereditary causes, since they often appear frequently within the same family. The person with relatives affected by a duodenal ulcer has two to three more chances of suffering. In addition, people with blood type 0 are more likely to have a duodenal ulcer. This is because they lack certain blood group antigens in gastric juice and saliva. These observations can be determined by a hereditary tendency to ulcers. However, exact connections remain unknown.
Another possible trigger of a duodenal ulcer is the consumption of nicotine and alcohol. Nicotine increases the nocturnal secretion of gastric juice, thus promote already existing imbalance between the protective and harmful factors of the mucosa. However, the negative effect of alcohol on the gastric mucosa and duodenum has nothing to do with the production of gastric juice. At high concentrations, alcohol directly affects the cells of the mucosa and causes damage that may be the starting point for the formation of ulcers.
There are also psychological and stress factors that can lead to a duodenal ulcer. This is the case of a high degree of stress, which can increase the disorders of an existing ulcer. People who are suffering from depressions also show a greater tendency to develop a duodenal ulcer.
What are the symptoms of duodenal ulcer?
The symptoms that appear in the case of a duodenum ulcer are not too prominent or characteristic, since other diseases show similar symptoms, especially a gastric ulcer. The most frequent discomfort of a duodenal ulcer is pain in the epigastrium, mainly at night and during fasting (pain in the stomach). At the center of the pain is often between the navel and the center of the right costal arch. In some cases, these pains can be relieved temporarily by ingesting food.
Other symptoms of duodenal ulcer are the pressure and the feeling of heaviness in the epigastrium flatulence, nausea, vomiting and weight loss. Stressful situations, consumption of coffee and nicotine can also reinforce the symptoms of a duodenal ulcer.
How is duodenal ulcer diagnosed?
In the case of duodenal ulcer, it is not usually enough to know the previous symptoms of past ulcerative diseases and perform a physical examination, since this information only offers the first indications of a gastrointestinal disease. In general, it is not possible to differentiate between a gastric ulcer and a duodenal ulcer only through symptoms and pain. And the same thing happens when it comes to determining whether it is just an irritation or a real ulcer. To perform the diagnosis of a duodenal ulcer, the following examinations are required.
In case of suspected duodenal ulcer, gastroduodenoscopy is the best way to diagnose a duodenal ulcer. Contrary to what happens with a gastric ulcer, it is not necessary to remove a sample of the duodenum tissue (biopsy), since the duodenum ulcer only develops malignant tumors in extremely infrequent cases. That is why it is only done when it is necessary to clarify atypical results or to determine a Helicobacter pylori infection.
If it is not possible to perform a gastroduodenoscopy when determining a duodenal ulcer for medical reasons, contrast radiography (passage of the stomach and intestine) does allow the diagnosis.
The diagnosis of duodenal ulcer is also the determination of Helicobacter pylori, since this bacterium is between 90 and 99% of all duodenum ulcers. There are special tests for determining Helicobacter pylori:
On the one hand, the concentration of antibodies in the blood can be analyzed. If antibodies against the bacterium are found there, the possibility of an infection at that time is quite high. However, the concentration of antibodies may continue to exist for a long time after a successful treatment, so, this diagnosis of duodenal ulcer is only partially representative.
Another possibility to detect Helicobacter pylori is the so-called 13C or 14C urea breath test. The patient is taking a test meal containing urea labeled with a radioactive isotope. If there is a Helicobacter pylori infection, the urease enzyme produced by the bacterium transforms the 13C or 14C carbon-labeled urea into carbon dioxide. Upon exhaling, the air is condensed in a vessel that determines the amount of carbon dioxide contained therein. In this way the pathogen causing a duodenal ulcer can be determined with high probability. Note that the urea labeled with radioactive substance is extremely minimal and does not damage.
In addition, a duodenal ulcer attached to an existing Helicobacter pylori infection can also be determined with a biopsy extracted from gastroduodenoscopy. If bacteria exist, a culture of bacteria is performed. A urease test taken from the biopsy may also be performed to make the diagnosis. The values of the laboratory can help to determine the possible diseases that underlie a duodenal ulcer.
How is duodenal ulcer treated?
In the case of a duodenal ulcer, the first step in treatment is to relieve pain with general palliative measures. If you suffer from a duodenal ulcer, it is advisable to follow a diet that reduces foods that feel bad to the stomach, such as coffee, alcohol, spicy spices and fatty substances such as chocolate. In the case of smoking, this bad habit should be abandoned for the moment. It is also important for the patient to find out what foods cause discomfort and avoid them. In addition, if you suffer from a duodenal ulcer it is advisable to try to avoid stress or at least to control situations that motivate you with appropriate strategies. If possible, avoid ingesting medications that damage the gastric mucosa, such as acetylsalicylic acid.
Drugs are the most successful treatment to cure a duodenal ulcer, since they inhibit the production of gastric acids. Because the hypersecretion that originates from an acidic gastric acid is fundamental in the appearance of an ulcer Of the duodenum.
If you have been diagnosed with a Helicobacter pylori infection, it is recommended that you take antibiotics to combat duodenal ulcer. There can be some cases in duodenal ulcer which may require surgery. Surgeon usually removes a part of the stomach (resection) to reduce the formation of gastric acid. Only in special cases, the duodenal ulcer operation forces the nerve supply of the acid-producing lining cells into an intervention called a vagotomy.
Prognosis of duodenum ulcer
Normally, a duodenum ulcer is treated with medication has a fairly good prognosis of cure. The success rate is in 90% of cases. However, it is frequent that it reproduces again (relapse). This can be avoided by taking the appropriate precautionary measures.
Complications of duodenum ulcer
In the evolution of duodenal ulcer, several complications can occur: Small bleeding that occurs for a long time may go unnoticed and end up causing anemia. In addition, it may also be that the duodenal ulcer bleeds are larger and the stools have a dark smelly color as well as degraded blood (melena) even producing excessive and copious bleeding that can lead to a hypovolemic shock (acute decrease in volume of the blood).
When it reaches adjacent organs such as the pancreas, large intestine or liver and forms fistulas. The consequence is strong pains that usually manifest especially in the back.
A very dangerous complication when the duodenum ulcer is widely spread is that it bleeds through all the layers of the walls of the intestine and causes a perforation of the intestine, which results in the contents of the intestine and air in the stomach passing into the cavity abdominal. The following process is an acute inflammation of the peritoneum (peritonitis).
If the duodenum ulcer is next to the stomach, it can lead to an infectious disease whose evolutionary process will give rise to a scarring that in turn will cause a narrowing of the exit of the stomach. This would prevent the passage of food, which is why the affected can only ingest small portions and often lead to vomiting and weight loss. At an advanced stage, the so-called hourglass stomach is formed, characterized by an extremely dilated body and a very narrow outlet.