A B C D E F G H I J K L M N O P R S T U V W

ULCER OF THE DUODENUM

How does Ulcer of the Duodenum occur ?

Ulcers are formed when the layer of mucus becomes damaged. This allows the hydrochloric acid which is made in the stomach to penetrate the surface of the duodenum. It is not known how the initial damage occurs. When ulcers heal, scarring develops, remaining a weak point where an ulcer can flare up again.

Why does Ulcer of the Duodenum occur ?

Some families do seem to have more members affected by ulcers, but this may not be entirely hereditary. Ulcers are known to be triggered by many different factors. Smoking and alcohol are common causes. Painkillers like aspirin and other anti-inflammation drugs commonly break down the mucus barrier, causing an ulcer. Steroid (cortisone-like) drugs can increase acid in the stomach. All these factors not only make ulcers occur, but make existing ulcers more likely to bleed or perforate (burst). Stress creates more gastric acid. Whether it is a cause is not certain, but it can aggravate existing ulcers. A bacterium, Helicobacter pylori , is commonly found in the stomachs of people with duodenal ulcers. The bacterium is usually diagnosed by removing small pieces of the stomach (biopsies) and sometimes by eating a special food and then testing the patient's breath. H. pylori can also be found by a blood test. This will show if there has ever been infection due to H. pylori , but not necessarily if the infection is current. Another test, using saliva, is being developed. If the bacterium is present, then therapy with bismuth and antibiotics is given.

Treatment Involved for Ulcer of the Duodenum

Usually your duodenal ulcer will need to be confirmed by either a barium meal x-ray or by an upper gastrointestinal (GI) examination (endoscopy). This enables the position, size and depth of your ulcer to be assessed. Duodenal ulcers heal very slowly. Diet is not as important as was previously thought. It is sensible for you to have small, frequent meals. Some people may be aware that certain foods (e.g. coffee or spicy foods) aggravate their symptoms. If this is the case, these foods are best avoided. You should stop or at least reduce alcohol to a minimum. Smoking must be stopped once and for all. It stimulates acid and will delay healing. Antacids are given to neutralize the stomach acid: ideally take them four or more times a day after food. These work by coating the ulcer and protecting it from acid. Acid reducing tablets (H 2 -blockers) like cimetidine, ranitidine and omeprazole block the release of acid into the stomach. They are often prescribed to heal the ulcer and sometimes on a long-term basis to stop the ulcer from coming back. They should not be used just when pain occurs but must be taken daily and continuously until the doctor advises that they should be stopped. If there is evidence of a current infection with H. pylori , then treatment is with a combination of drugs. The treatment may include antibiotics, H 2 blockers, or other acid-educing drugs, such as omeprazole and bismuth. There are various treatment regimes using combinations of two or three of the drugs. It is also important to examine your lifestyle and look at ways of reducing stress, both at home and at work. You should discuss this with your doctor, so that he can help you to achieve this. The pain from most ulcers can be dealt with by these measures (sometimes the doctor will use other drugs as well). An operation is usually needed only for ulcers that perforate (burst) and occasionally for those that bleed (peptic ulcer surgery).

During Treatment for Ulcer of the Duodenum

Symptoms usually improve by the end of the first week. Notify the doctor if any pain or indigestion is still present after 3 weeks. Diarrhoea, rash, tiredness and muscle pain occasionally occur with H 2 -blockers. Some elderly people get a little vague and confused with this group of drugs. The doctor needs to be told about any of these side-effects. Treatment for Helicobacter pylori can cause diarrhoea and dark stools. You will probably be asked to see your doctor 2 to 4 weeks after starting treatment to check progress. A repeat endoscopy may be necessary. Bleeding of ulcers can occur. Vomiting of blood or coffee grounds material or the passing of black bowel motions are a sign of this. Sometimes, there may be just faintness (due to a fall of blood pressure), or paleness (due to anaemia), particularly if the bleeding is slow or on-and-off. The doctor needs to know immediately if any of these occur. Perforation (bursting) of an ulcer produces more or less severe, continuous upper abdominal pain. You may look very pale, become sweaty, and may collapse, and will need to go to hospital immediately.

After Treatment

Ulcers often recur. The length of time between attacks varies from 1 to 6 months. Chronic ulcer disease may occasionally cause a blockage of the pyloric canal due to scarring. This is called pyloric stenosis . It produces a feeling of bloating and vomiting and needs to be treated by operation. After an ulcer has been treated, it is especially important that you avoid any factor which could cause it to flare up again. Some people are treated almost indefinitely with H 2 -blockers to prevent recurrence. Some highly stressed people with duodenal ulcer may benefit from relaxation treatment, or even a change in job.

If Ulcer of the Duodenum is left untreated

Many ulcers will eventually heal by themselves, but there is a greater risk of delayed healing, bleeding or bursting. Untreated ulcers are also more likely to produce pyloric stenosis.

Effects on Family of Ulcer of the Duodenum

People close to you need to know that this is a disorder which does not disappear overnight. They may be very helpful in reminding you to take medication regularly!