Duodenal Ulcer

Description

A duodenal ulcer (Ulcus duodeni) is a lesion in the mucous membrane of the duodenum - the first part of the small intestine below the stomach. Both the upper or surface layer and the entire mucous membrane can become damaged. Statistically, more men than women are affected by the disease. Duodenal ulcers occur more often than gastric (stomach) ulcers. Characteristic of both types of ulcers is that the symptoms and pain occur in connection with food intake, however with duodenal ulcers these often appear on an empty stomach (hunger pains) or at night, and the symptoms improve temporarily after ingesting food. The duodenal ulcer is typically located in the upper part of the duodenum. Increased incidence of the disease is observed in spring and autumn.

Symptoms

The main symptom of duodenal ulcers is pain in the upper abdomen. But often general symptoms such as anorexia, nausea, vomiting, a feeling of pressure or bloatedness, or weight loss may be the first signs of the disease. Typical of the duodenal ulcer is an often burning pain occurring about two hours after food intake, localized in the areas of the central upper abdomen or around the navel.

Causes and Risks

The formation of a duodenal ulcer can have several causes, however a chronic infection with the bacterium Helicobacter pylori is one of the main triggers. Usually an imbalance in the relationship between the mucus protective factors (mucus, bicarbonate, prostaglandin) and aggressive elements such as stomach acid, proteases and inflammation is responsible for the development of duodenal ulcer. Also, circulatory disorders of the intestinal wall can cause its formation, as well as taking medication (especially painkillers or anti-inflammatory drugs) or else psychosomatic factors.

Duodenal ulcers can be associated with multiple complications, the most common among them bleeding (blackening of the stool, vomiting blood) and a perforated ulcer, which can lead to inflammation of the peritoneum (peritonitis).

Examination and Diagnosis

In case of persistent discomfort a gastroscopy (esophagogastroduodenoscopy) should be carried out to clarify the problem. At this point samples (biopsies) can be taken from suspicious-looking areas for additional histological examinations, to ascertain the presence of the bacteria Helicobacter pylori or other disease-causing agents. In the so-called rapid urease test (RUT), tissue samples are put in contact with a urea-containing liquid. If bacteria are present in the biopsy material, the urease splits the urea and the liquid will stain. Another way to detect the bacteria Helicobacter pylori is the 13C-urea breath test. In this, the patient drinks a test solution with Carbon-13-tagged urea. The Carbon-13-tagged carbon dioxide released by the bacterial urease after splitting can be detected in the exhaled air, giving an indication of the presence of Helicobacter pylori.

Treatment

If the Helicobacter pylori bacteria is detected, so-called eradication therapy is necessary. This involves a combination of two antibiotics and an antacid. The intake must take place over at least seven days. The selection of appropriate drugs is influenced by several factors (antibiotic treatment in the medical history or resistance expected). Eradication therapy generally leads to the successful elimination of bacteria and protects against the emergence of new duodenal ulcers.

The form of duodenal ulcer not caused by Helicobacter pylori can be treated symptomatically: onerous causative factors such as stress, alcohol consumption and smoking should be minimized or avoided. At the same time, antacids are used to regulate the production of stomach acids and promote healing of the ulcer. Surgical intervention is usually no longer necessary these days, however complications (e.g. perforation of the stomach) may lead to emergency surgery.

Course and Prognosis

After medicinal treatment, it is very rare to relapse and reinfect with Helicobacter pylori bacteria: the eradication therapy success rate is about 90 percent. Within the scope of conservative treatment, adhering to a diet, abstaining from nicotine and alcohol, avoiding stress and taking antacid preparations will lead to long-term therapeutic success.

Miscellaneous/Other Comments

What must be considered before an esophagogastroduodenoscopy (EGD)?

For a meaningful diagnosis of Helicobacter pylori, acid-blocking drugs must be discontinued 2 weeks prior to EGD, and furthermore a 4-week interval from the last antibiotic treatment must be observed. The attending physician can explain the specific precautionary measures and risks of endoscopic examination beforehand.