Duodenal ulcer

definition

The Duodenal ulcer (Duodenal ulcer) is an inflammatory one Intestinal mucosal wound in the area of Duodenum (Duodenum). The duodenum is the first section of the small intestine following the stomach. The ulcer, i.e. the wound, extends over the muscle layer of the small intestinal mucosa (Lamina muscularis mucosae). Dangerous complications arise once the ulcer Blood vessels, especially arteries, in the wall as it attacks so too heavy bleeding can come. In rare cases it can even lead to a breakthrough the intestinal wall come.

The Duodenal ulcer belongs to the group of gastroduodenal ulcer disease, so is closely related to that Gastric ulcer related because the same disease mechanism is present. The duodenal ulcer occurs about five times as often as the gastric ulcer.

Usually the ulcer is on the front or back wall of the first part of the duodenum, that is just behind the stomach outlet.

treatment

The goals of therapy are one Accelerate healing of the duodenal ulcer, while at the same time KMinimize complications and pain would like to. The therapy consists of general, medicinal and operative aspects.

General therapy lays a supporting foundation for drug therapy and helps prevent recurrences over a long period of time. The most important point here is on Refrain from nicotine in. Even with one Adjusting the diet Healing can be accelerated and pain reduced (see diet). Painkillers such as ASA (e.g. Aspirin®) or ibuprofen should - if possible - be discontinued or by another, less gastric pain reliever replaced, this can be done after consulting the attending physician.

The aim of drug therapy is that Neutralize aggressive stomach acid or reduce their education. The biggest roles play here PPIs (Proton pump inhibitorse.g. Pantoprazole, Omeprazole) that the Directly reduce gastric acid build-up. Other drugs such as antacids (neutralization of the acid) or histamine-2-receptor antagonists (reduced acid formation) hardly play a role nowadays.

Became a Helicobacter pylori infection verified, a Antibiotic therapy ("Italian" or "French" triple therapy) carried out around the Treat infection by Helicobacter pylori. The duodenal ulcer usually heals afterwards without any problems. Becomes no Helicobacter pylori infection proven so as a rule a vFour-week therapy with proton pump inhibitors initiated. If there is a recurrence, i.e. a recurrence of ulcers, this therapy can be continued after medical advice.

It is important in drug therapy that the Medication can be taken to the end as directed, even when the symptoms have subsidedso that the duodenal ulcer can heal completely. Intermittent therapy is only recommended in rare cases, i.e. taking medication when symptoms are present and stopping when the symptoms subside. With this form of therapy, regular endoscopic monitoring of the ulcer is important as there is an increased risk of cancer.

One operative therapy is usually only with one perforation or if you have massive bleeding necessary.

As a prophylaxis, low-dose proton pump inhibitor therapy can be carried out over a long period of time. If drugs such as aspirin or ibuprofen have to be taken regularly, preventive therapy with proton pump inhibitors should be carried out.

Which drugs help against a duodenal ulcer?

For the treatment of a duodenal ulcer, as mentioned above, as a rule, the main Proton pump inhibitors used. These are drugs that they Significantly inhibit acid production in the stomach. Since stomach acid is the most damaging trigger in the development of an ulcer, a noticeable one usually occurs after a few days of ingestionn Decrease in complaints. Proton pump inhibitors include pantoprazole and omeprazole.
Is there a Helicobacter pylori infection before so this must be eliminated. There is also the so-called eradication therapy which consists, for example, of two antibiotics and a proton pump inhibitor. This combination of three must then be taken for seven days.
Medicines from the group of antacids can also be used therapeutically. They neutralize stomach acid. They include, for example, sucralfate and aluminum hydroxide. Antacids have now largely been replaced by proton pump inhibitors.

Also read our topic: Proton pump inhibitors in comparison

Diet for a duodenal ulcer

In the presence of a duodenal ulcer should be on one healthy and balanced diet are observed. Sufficient fiber, which is mainly found in fruits, vegetables and whole grain products, no overly fatty and no spicy foods. Several small meals a day are recommended. Also on one sufficient amount of water to drink Care should be taken when doing this during the acute stage of the ulcer Carbonated drinks are more likely to be avoided, as is coffee.

In general, no specific diet is necessary for a duodenal ulcer, but symptoms can be significantly improved with frequent, small meals that are regularly distributed throughout the day. In addition, it should be ensured that sThe above-mentioned “acid looseners”, which lead to an increased production of gastric acid, should be avoided. The classic "acid looseners" include alcohol, coffee and other beverages containing caffeine (Cola!), As well as citrus juices.

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Home remedies for a duodenal ulcer

If there is an ulcer of the duodenum, it should be not treated with home remedies, but with effective drugs. You should therefore see your family doctor, who will then decide on further therapy. An untreated ulcer can lead to serious complications and should therefore always be treated, home remedies alone are not a solution in this case.

As a supplement, home remedies can be used in consultation with the attending physician. Home remedies apply stomach-friendly food, such as semolina and gruel. Regular consumption of Vermouth tea can also provide an improvement, not least because wormwood has an anti-inflammatory and digestive effect. Also Camomile tea and Melissa tea used as a home remedy for duodenal ulcers.

Homeopathy for a duodenal ulcer

Just like home remedies, homeopathic remedies should not be used for duodenal ulcers alone. as these usually do not lead to a cure. A lack of treatment can lead to the development of sometimes life-threatening complications such as bleeding.

causes

When the Duodenal ulcer plays the balance between protective (protective) and attacking (aggressive) Factors play a role in the intestinal mucosa. In a healthy body the aggressive stomach acid, which flows from the stomach into the duodenum through a protective Mucus layer neutralized on the intestinal mucosa. If this balance is destroyed, i.e. if there is more stomach acid than mucus, a duodenal ulcer develops.

The most common causes are Taking so-called NSAIDs (non-steroidal anti-inflammatory drugs such as Aspirin® (ASS), diclofenac and ibuprofen). These drugs reduce the production of protective mucus. These drugs are used along with Glucocorticoids (Cortisone, prednisolone), the risk of a duodenal ulcer increases again considerably.

Another common cause is that Infection with the bacterium Helicobacter pylori. This bacterium attaches itself to the cells of the stomach and duodenal lining and attacks them. The resulting The inflammatory reaction paves the way for ulcer disease. Those affected often experience increased gastric acid production with a simultaneous inhibition of protective factors such as the mucous layer that protects the mucous membrane. Result is a increased effect of stomach acid on the mucous membrane of the small intestine. If this happens over a long period of time, ulcers can develop.

Other important risk factors are increased stress, smoking cigarettes, i.e. the consumption of nicotine, excessive consumption of alcohol and the use of certain antidepressants (SSRIs - selective serotonin reuptake inhibitors, e.g. citalopram and fluvoxamine).

Some rare diseases can also promote the development of duodenal ulcers, such as a Overactive parathyroid gland, one Renal failure and the Zollinger-Ellison Syndrome, which is a hormone-producing tumor of the gastrointestinal tract, usually the pancreas.

You might also be interested in the following topics: Side effects of ibuprofen and Symptoms of Helicobacter pylori infection

Duration

Often, patients with duodenal ulcer have gone through a certain path of suffering. As the disease occurs frequently Develops slowly, no definite time to diagnosis can be given. If everything goes well, it often shows An improvement after one to two weeks of treatment with proton pump inhibitors. After four weeks of treatment, the disease is usually considered cured.

However, even after years it can Relapses, duodenal ulcers recur, especially when taking certain painkillers (NSAIDs such as ibuprofen or diclofenac and others) and when smokers.

cure

When therapy with Acid inhibitors such as pantoprazole or omeprazole is initiated, the ulcer usually heals gradually. The pain usually subsides a few days after starting drug therapy. However, it can take months for the ulcer to heal completely.

Can a duodenal ulcer become cancerous?

Malignant degeneration rarely occurs in duodenal ulcers. In gastric ulcers, malignant degeneration occurs in approx. 1-2% of patients; in duodenal ulcers, degeneration is significantly less common.

With chronic disease processes degeneration is generally more likely, which is why at least An endoscopic examination should be carried out every two to three years. If a duodenal ulcer is treated medically, degeneration is much less likely.

Duodenal Ulcer Or Cancer - How To Differentiate?

Ulcers of the duodenum develop Rare into cancer. More often this can be the case with gastric ulcers. In order to be able to make a reliable distinction between ulcer and cancer, a Sampling from the affected area. The specimen must then be examined in a histological manner in a pathological institute, where a diagnosis can then be made.

Symptoms

The leading symptom is what is known as the Fasting pain in the upper abdomena pain that persists if you haven't eaten. It often improves when you start to eat or when you take one Antacid (a drug that neutralizes stomach acid). The symptoms are mostly severe in the morning.

More symptoms can be Nausea and vomiting be. If there is already chronic bleeding from the duodenal ulcer, the Symptoms of anemia (anemia) make noticeable: tiredness and reduced resilience, shortness of breath, especially during exercise, paleness (especially of the mucous membranes) and possibly palpitations. In rare cases blood or tarry stools may break (the stool is then usually not red but black, which is caused by the clotted blood that has been transformed in the intestine).

The symptoms like Abdominal pain and bloating can be aggravated in some sufferers by the consumption of alcohol or nicotine.

A duodenal ulcer however, it can also be completely without symptoms run away.

Signs

The first signs of a duodenal ulcer are Upper abdominal pain, especially in the morning or after a period of time without foodthat get better after eating. If the symptoms persist over a long period of time, a certain period can be seen in which the pain is better at some times than at other times. Studies have shown that the pain mainly occurs in spring and autumn.

Signs of a acute bleeding often occur without previous abdominal discomfort, instead a shock (volume deficiency shock, i.e. too little blood in the vascular system due to blood loss through bleeding) with accelerated breathing, palpitations, a drop in blood pressure, paleness, cold sweats, confusion and "out of the blue" occurs instead Unconsciousness.

Back pain

Back pain can occur when the upper abdominal pain radiates. This type of radiation is more common in gastric ulcers, however, a distinction between the two localizations cannot be made on the basis of this symptom.

Sometimes the pain can radiate into the shoulder or chest, but these are all very unspecific charactersas they are also used in many other diseases. In addition, the pain radiates differently in every person.

Bleeding from a duodenal ulcer

At approx. every tenth patient with a duodenal ulcer, bleeding occurs once in the course of the disease. Depending on the size of the bleeding, these acute symptoms can lead to circulatory shock and become dangerous, or they can be chronic over a long period of time.

These are typical signs of bleeding Vomiting blood (Hematomaesis) and tarry stools (Melena). This is a Black discoloration of the stool due to rebuilt blood in the intestine. At a chronic bleeding step through the constant blood loss the symptoms of anemia (anemia): tiredness and reduced resilience, shortness of breath, especially during exertion, paleness (especially of the mucous membranes) and possibly palpitations.

The diagnosis is made by an endoscopy of the esophagus, stomach, and duodenum (esophagogastroduodenoscopy). It must be determined how heavy the bleeding is. As a rule, it is also treated endoscopically. The source of bleeding can be treated in different ways:

• by Injection (Very diluted adrenaline is injected into the bleeding lining of the intestine, which causes the blood vessels to contract and the bleeding to stop),
• by Fibrin glue (Here a spray consisting of fibrin components is applied to the bleeding, which causes the natural formation of blood clots and thus stops the bleeding),
• by mechanical "Clipping“(In this case, clips made of metal are pressed onto the bleeding vessel similar to a staple clip, whereby the bleeding is stopped mechanically) or
• by Coagulation (Here the bleeding vessel is burned with the help of a targeted electrical impulse, which closes the wound quite reliably).

In the rarest of cases, the bleeding cannot be controlled in this way and an operation has to be performed.

Diarrhea from a duodenal ulcer

Diarrhea is not really a typical symptom of a duodenal ulcer. If both occur together, the diarrhea usually has a different cause than the ulcer.

Flatulence in a duodenal ulcer

Flatulence is a symptom that can be more common with duodenal ulcer. However, it is unspecific as gas can occur in numerous situations. Much more typical is fasting pain in the area of ​​the upper abdomen which can show up at night, for example.

diagnosis

The diagnosis of duodenal ulcer consists of several steps.
First, a detailed patient interview (anamnese) made with subsequent examination of the patient.
Rarely is a rectal examination carried out by palpation in which invisible - so-called occult - blood can be detected in the stool.

A reliable diagnosis is made by a gastrointestinal mirror (Esophago-gastro-duodenoscopy), whereby the examining doctor can view the ulcer himself and take several small samples of the affected intestinal mucosa, which are then examined. Either the throat is numbed with a spray or there is a short anesthetic. Then the examiner inserts the gastroscope through the mouth and passes through the esophagus and stomach to the duodenum. The mucous membrane of the esophagus, stomach and duodenum can be assessed with a camera. In order to be able to diagnose an ulcer with certainty, a sample must be taken from the affected area (biopsy) can be taken. This is done as part of a gastroscopy. This sample is then sent to a pathological institute, where it is examined in terms of tissue (i.e. under a microscope). The diagnosis can ultimately only be made under the microscope. The main focus is on a Helicobacter pylori infection and a malignant degeneration of the cells. The collection must take place because a certain proportion of the ulcer can become malignant (malignant can degenerate) and you definitely don't want to overlook them.

The test for Helicobacter pylori is done to clarify the development of the duodenal ulcer. If bacteria are found, they are initially assumed to be the cause; if none are found, taking medication (certain painkillers) is the most likely cause.

If there is an acute suspicion of perforation of the intestinal wall, an X-ray examination should be attempted. The patient swallows an X-ray contrast medium in the form of porridge while the upper abdomen is X-rayed. Here it can be observed whether the contrast agent leaks out of holes in the intestinal wall. This clearly speaks in favor of a perforation.

If no improvement is achieved even after long therapy, long-term pH-metry can be carried out. Here, the pH value in the duodenum is measured with the help of an electrode over a period of 24 hours. It can show increased acid levels, as a sign of dysfunction and as a cause of the duodenal ulcer.

Read more on the topic: pH, ultrasound of the abdomen