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Duodenal ulcer

Overview

A duodenal ulcer is a type of peptic ulcer that forms in the duodenum, which is the first part of the small intestine just after the stomach. It is a common type of ulcer and typically occurs when the protective lining of the duodenum is eroded, leading to an open sore or lesion.

  • Helicobacter pylori (H. pylori) infection: This bacterium is a major cause of duodenal ulcers. It disrupts the mucosal lining and triggers inflammation, making the duodenum more vulnerable to acid damage.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs): Long-term use of NSAIDs (e.g., ibuprofen, aspirin) can damage the stomach and duodenal lining by inhibiting prostaglandins, which protect the mucosal lining.
  • Excessive acid production: In some cases, increased gastric acid production may contribute to ulcer formation. This is often seen in conditions like Zollinger-Ellison syndrome, where tumours cause the overproduction of stomach acid.
  • Alcohol and smoking
  • Psychological stress: Although stress does not directly cause ulcers, it may exacerbate symptoms or interfere with healing.
  • Genetic factors

  • Abdominal pain: Often described as a burning or gnawing pain in the upper abdomen, especially on an empty stomach. The pain may improve temporarily after eating or taking antacids but often returns.
  • Bloating and belching
  • Nausea and vomiting
  • Loss of appetite
  • Indigestion (dyspepsia)
  • Black, tarry stools (indicating gastrointestinal bleeding)
  • Vomiting blood
  • Sudden, severe abdominal pain (which may indicate perforation)
  • Unexplained weight loss

  • Endoscopy (Gastroscopy): A flexible tube with a camera is inserted into the stomach and duodenum to directly visualise ulcers and take biopsies if necessary.
  • Barium swallow (Upper GI Series): X-rays taken after swallowing a contrast material can show ulcers in the duodenum.
  • H. pylori testing: Tests like urea breath test, stool antigen test, or blood antibody test can confirm the presence of H. pylori infection.
  • Blood tests: To check for anaemia (if bleeding is suspected) or signs of infection.

The treatment of duodenal ulcers focuses on relieving symptoms, promoting healing, and preventing complications. It includes:

  • Antibiotics (for H. pylori): If an H. pylori infection is present, a combination of antibiotics (e.g., amoxicillin, clarithromycin) and a proton pump inhibitor (PPI) is used to eradicate the bacteria.
  • Proton pump inhibitors (PPIs): Medications like omeprazole, esomeprazole, or pantoprazole reduce stomach acid production, allowing the ulcer to heal.
  • H2-receptor antagonists: Medications like ranitidine or famotidine also reduce acid production but are less potent than PPIs.
  • Antacids and H2 blockers: These can help neutralise stomach acid and provide symptom relief.
  • Antibiotics (if needed): For H. pylori infection.
  • Avoidance of NSAIDs: Stopping the use of NSAIDs or switching to alternative pain-relief options is crucial if they are contributing to the ulcer.
  • Lifestyle modifications: Avoid smoking, limit alcohol consumption, and manage stress.
  • Surgical treatment: Surgery is rarely needed but may be required if the ulcer is large, doesn't heal with treatment, or causes complications such as bleeding, perforation, or obstruction.

  • Limit NSAID use: Use NSAIDs only when necessary and with caution.
  • Eradicate H. pylori: If you are diagnosed with an H. pylori infection, complete the prescribed antibiotic regimen.
  • Avoid smoking and excess alcohol: Both can increase the risk of ulcers.
  • Manage stress: Engage in stress-reduction techniques like exercise, yoga, or meditation.
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