A chronic gastrointestinal tract disease in which ulcers occur on the walls of duodenum is called duodenal ulcer. Once of the main duodenal ulcer causes is H. Pylori infection. Duodenal ulcer treatment required, first of all, to eradicate H. Pylori completely, if it is present. In addition, the treatment plan will usually include a range of measures aiming to promote healing of an ulcer. Below we are going to discuss in more details the nature of this disorder, its symptoms, treatment options and diagnostics services.
WHAT IS A DUODENAL ULCER?
When food passes down the oesophagus into the stomach. The stomach makes acid that is not essential but helps to digest food. The food passes into the first part of the small intestine (the duodenum) after it goes through the stomach.
In the duodenum and the rest of the small intestine, food mixes with chemicals called enzymes.
Where do the enzymes come from and what do they do?
The enzymes come from the pancreas and from cells lining the intestine. The enzymes break down the food that is then absorbed into the body.
Your stomach normally produces acid to help with the digestion of food and to kill bacteria. Some cells on the inside lining of the stomach and the duodenum produce a natural mucous barrier for protection. There is normally a balance in the acid produced and the protective mucous barrier produced. An ulcer may develop if there is an alteration in this balance.
What happens when there is an alteration in the balance?
- Infection with Helicobacter pylori( pylori): About 19 to 20 cases of duodenal ulcer is caused by H. pylori infections. Once infected, it will stay for the rest of your life, unless it has been treated. It doesn’t cause problems for most people and a number of these bacteria live harmlessly in the lining of your stomach and duodenum. However, it may cause inflammation in some people. The defence mucous will be disrupted allowing the acid to cause inflammation and ulcers.
- Anti-inflammatory medicines – including aspirin: Also known as non-steroidal anti-inflammatory drugs (NSAIDs). There are various types and brands. For example:
Many patients take these medicines for arthritis and muscular pains. Aspirin is used to avoid blood clots. However, these medicines can sometimes affect the mucous barrier of the duodenum and allow acid to cause an ulcer.
About 1 in 20 duodenal ulcers are caused by anti-inflammatory medicines.
What are some other duodenal ulcer causes and factors?
Some other causes include the Zollinger-Ellison syndrome. This is a rare condition, much more acid than usual is produced by the stomach. Other factors such as:
- Drinking heavily
These are all factors that may possibly increase the risk of having a duodenal ulcer. However, they are not usually the underlying cause of duodenal ulcers.
DUODENAL ULCER SYMPTOMS
You may experience duodenal ulcer symptoms daily or just once in a while. At times any of these abdominal symptoms can be severe:
- Abdominal bloating
- Burning stomach
- Upper abdominal pain that may be severe
- Feeling of fullness
- Loss of appetite
- Nausea with or without vomiting
- Unintentional weight loss
Sometimes, the duodenal ulcers can be life threatening. In these cases, you should seek immediate attention if you have any of the symptoms below:
- Blood in stool
- Severe abdominal pain
- Vomiting blood
DUODENAL ULCER TREATMENT OPTIONS
- Acid-suppressing medication: This is a four to eight week course of medicine that greatly reduces the amount of acid your stomach produces. Proton pump inhibitor (PP) is the most commonly used medicine. These are a class of medicines that work on the cells that line the stomach to reduce the production of acid. They include:
Another class of medicines called H2 blockers are sometimes used. They are also known as histamine H2-receptor antagonists but are normally called H2 blockers. They work in a different way on the cells that line the stomach to reduce acid production. They include:
As the amount of acid is greatly reduced, the ulcer normally heals. However, that’s not the end of the story.
- If your ulcer was caused by H. pylori: Almost all duodenal ulcers are caused by infection with H. pylori. Therefore, a main part of the treatment is to clear this infection.
If it is not cleared, the ulcer is likely to return once the acid-suppressing medication stops. There are two types of antibiotics to be taken. On top of that, you need to take an acid-suppressing medicine to reduce the acid in the stomach. This is required to allow the antibiotics to work well. You will need to take this combination therapy also known as triple therapy for a week.
In 9 to 10 cases, one course of combination therapy clears H. pylori infection. When H. pylori is cleared, the chance of a duodenal ulcer returning is greatly reduced. However, in a small number of patients, H. pylori infection will return at some stage in the future.
After treatment, a test will be conducted to check that H. pylori has been successfully removed. This test needs to be done at least four weeks after the course of combination therapy has finished. Mostly, the test is negative meaning that the infection has gone.
If it is still present then a repeat course of combination therapy with a different set of antibiotics may be advised. Some doctors say that for people with a duodenal ulcer, this test will not be necessary.
- If your ulcer was caused by an anti-inflammatory medicine: In this case, you should stop the anti-inflammatory medicine if possible. This allows the ulcer to heal. An cid-suppressing medicine for several weeks (as mentioned above) will also normally be prescribed. This stops the stomach from making acid and allows the ulcer to heal.
In many cases the anti-inflammatory medicine is required to ease symptoms of arthritis or other painful conditions or aspirin is needed to protect against blood clots.
In situations like these, one option is to take an acid-suppressing medicine each day indefinitely. This reduces the amount of acid produced by the stomach and greatly reduces the chance of an ulcer forming again.
- Surgery : Surgery was commonly used to treat a duodenal ulcer. In fact, it was needed to treat this condition. However, this was before it was discovered that H. pylori was the cause of most duodenal ulcers and before modern acid-suppressing medicines became available. Surgery is only needed now if a complication of a duodenal ulcer develops such as severe bleeding or a hole (perforation).
- History taking and physical exam: Your doctor will ask you questions about your symptoms, lifestyle and eating habits, as well as about your family history of medical conditions. Then he will perform a physical examination, which includes palpating your tummy area. All these is going to provide him a clearer picture of your condition.
- Gastroscopy (endoscopy): This test can confirm a duodenal ulcer. The doctor will look inside your stomach and the first part of your duodenum. A thin and flexible telescope is inserted down your oesophagus to allow the doctor to see any inflammation or ulcers.
- A test to detect the H. pylori germ (bacterium): If you have duodenal ulcers, this test is normally performed to detect the bacteria. If H. pylori bacteria is found then it is most likely the cause of the ulcer. This condition can also be detected through a stool sample, a breath test, a blood test or from a biopsy sample taken during endoscopy.