What is a duodenal ulcer?

Definition

A duodenal ulcer is a peptic ulcer that is located in the duodenum, the
upper part of the small intestine where it attaches to the stomach. The ulcer is a
sore on the lining of the duodenum.

Causes

More than one-half of the cases of duodenal ulcer are caused by
infection with a bacterium called
Helicobacter pylori (H. pylori). Aspirin and ibuprofen are examples of nonsteroidal anti-inflammatory drugs
(NSAIDs) that can also cause duodenal ulcers. Rarely, tumors
that are benign (not cancerous) or malignant (cancerous) may cause ulcers. Eating
spicy foods, stress, smoking, and drinking alcohol do not cause, but do often
worsen the symptoms of, ulcers.

Risk Factors

Infection with H. pylori is common. Infections can develop in childhood without causing symptoms until later in life. Drinking contaminated water or eating contaminated food increases the risk of taking in the bacterium. Food that is not properly washed or cooked increases the chance of infection. Contact with the saliva, vomit, or feces of an infected person may also transfer the bacterium.

Symptoms

Discomfort in the abdomen is the most common symptom, but some people have no
symptoms or mild symptoms only. Discomfort may be a dull or burning pain
(heartburn) that lasts a few minutes or hours when the
stomach is empty, and episodes may continue for days or weeks. Discomfort may
improve after eating or taking antacids. Weight loss, lack of appetite, burping,
bloating, nausea, and vomiting are all common symptoms. If sharp, persistent, and
severe pain or bloody vomit or bowel movements occur, one should consult a doctor
immediately.

Screening and Diagnosis

A physician usually makes the diagnosis by taking a careful history of drugs
used, especially prescription or over-the-counter NSAIDs, and by testing for
H. pylori. A breath test or stool test are more accurate at
finding H. pylori than are blood tests. If symptoms are severe, a
thin, lighted tube with a camera on the end (endoscope) is threaded down the
throat and through the stomach to the duodenum to look at the area
(endoscopy). Radiology (X-ray) tests of the upper
gastrointestinal tract may also be done.

Treatment and Therapy

The primary treatment for NSAID-related duodenal ulcers is stopping the drug
and using medicines that reduce stomach acid to decrease pain and promote healing
and coat the ulcer to protect it from stomach acid. For duodenal ulcers caused by
H. pylori, antibiotic therapy for ten to fourteen days usually
heals the ulcer. Different antibiotic regimens are used throughout the world
because the H. pylori bacterium has become resistant to some
antibiotics. This means that the drug is no longer effective
in killing the bacterium. Medicines to reduce acid and coat the ulcer are also
used. About four weeks after treatment, the person is tested again to see if the
H. pylori bacterium is gone.

Prevention and Outcomes

While it is not known how H. pylori spreads, the bacterium can be avoided with careful handwashing, especially after using the toilet and before eating, washing, and cooking food; drinking clean water; not sharing drinks and food with others; and using gloves when cleaning up vomit or bowel movements. Taking NSAIDs in recommended doses or only when needed may also prevent a duodenal ulcer.

Bibliography

Feldman, Mark, Lawrence S. Friedman, and Lawrence J. Brandt, eds. Sleisenger and Fordtran’s Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. New ed. 2 vols. Philadelphia: Saunders/Elsevier, 2010.

Kapadia, Cyrus R., James M. Crawford, and Caroline Taylor. An Atlas of Gastroenterology: A Guide to Diagnosis and Differential Diagnosis. Boca Raton, Fla.: Pantheon, 2003.

Kirschner, Barbara S., and Dennis D. Black. “The Gastrointestinal Tract.” In Nelson Essentials of Pediatrics, edited by Karen J. Marcdante et al. 6th ed. Philadelphia: Saunders/Elsevier, 2011.

McColl, Kenneth E. L. “ Helicobacter pylori Infection.” New England Journal of Medicine 362 (2010): 1597-1604.