duodenal ulcer in adults

Peptic ulcer is a serious problem of the digestive tract. With this pathology, in the initial part of the digestive tube – this is the stomach or small intestine, painful ulcers or erosions are formed that irritate the submucosal layer of tissues. Usually, the intestinal mucosa is thick from the effects of digestive juices and is protected by a layer of mucus and an alkaline environment that neutralizes acid. But many influences and pathologies can reduce this protective layer and reduce the alkalinity of the environment, allowing stomach acid to damage intestinal tissue.

What is a duodenal ulcer

A duodenal ulcer is an open sore that occurs when the protective mucus that lines the intestinal wall breaks down. Bacteria, stomach acid, and digestive enzymes can damage both the protective layer and deeper tissues, resulting in unpleasant symptoms.

Gastric ulcers as well as duodenal ulcers are commonly referred to as peptic ulcers.

Useful information about duodenal ulcer

Causes of duodenal ulcers in adults

Traditionally, duodenal ulcers were thought to be caused by a combination of stress, smoking, diet, and alcohol. While all of these may contribute, in the 1990s it was found that 95% of duodenal ulcers were caused by the bacterium Helicobacter pylori. This bacterium is transmitted to the child during childhood, but causes problems in most people only in adulthood.

Helicobacter pylori lives in the stomach and the initial section of the intestine in almost all adults. Although increased hygiene habits and food preparation practices reduce the risk of infection, infection is still widespread. Most people who have this bacterium in their gut have no symptoms, but under certain circumstances the germs can break through the protective mucus, damaging the gut wall and causing an ulcer.

H. pylori bacteria adhere to the mucus layer in the digestive tract and cause inflammation (irritation), which can lead to the gradual breakdown of this protective lining. This disorder is a problem because your stomach contains a strong acid designed to digest food. Without the protective layer of mucus, the acid can eat away at the stomach tissue.

However, for most people, the presence of H. pylori is not adversely affected. Only 10% to 15% of people with H. pylori develop ulcers.

Another factor contributing to this may be long-term use of conventional painkillers, especially acetylsalicylic acid, Ibuprofen or Diclofenac. These drugs belong to a group of painkillers known as non-steroidal anti-inflammatory drugs (or NSAIDs for short), which provoke severe irritation of the mucous membranes, which threatens with prolonged use, the risk of erosions and then ulcers.

NSAIDs can destroy the lining of the digestive tract. Acetaminophen (paracetamol) is not an NSAID and will not harm your stomach. People who cannot take NSAIDs are often advised to take acetaminophen.

Not everyone who takes NSAIDs will develop ulcers. However, the appointment of NSAIDs in combination with the presence of H. pylori in the digestive tract is potentially the most dangerous. People who are found to have H. pylori and take long-term NSAIDs are more likely to have mucosal damage, and their damage may be more severe. Ulcers due to taking NSAIDs also increase if:

• the person takes high doses of NSAIDs and does so frequently;
• age is 70 years and older;
• they are women;
• Corticosteroids (drugs your doctor may prescribe for asthma, arthritis, or lupus) have been prescribed along with anti-inflammatory medications
• taking NSAIDs continuously for a long time;
• history of peptic ulcer disease.

It is extremely rare for intestinal ulcers to be provoked by other factors. Ulcers may develop after:

• severe illness, past viral or microbial infections;
• transferred operation.

Peptic ulcers can also occur with a rare condition called Zollinger-Ellison syndrome (gastrinoma). This condition forms a tumor of acid-producing cells in the digestive tract. These tumors can be malignant or benign. The cells produce an excessive amount of acid, which damages the tissues of the digestive tube.

Symptoms of a duodenal ulcer in adults

A recent study in Sweden found that 4% of the general population has a stomach ulcer or duodenal defect but usually does not show symptoms. Some people have mild symptoms that come and go and are ignored, but a duodenal ulcer is unlikely to go away without treatment. Relatively mild symptoms of a duodenal ulcer include:

• gnawing or burning pain in the middle or upper stomach between meals or at night;
• bloating;
• a feeling of very rapid satiety;
• nausea;
• heartburn;
• bitterness in the mouth;
• in the longer term, weight loss.

Symptoms that are more difficult to manage include:

• Pain in the abdomen or stomach, usually just below the pit of the chest, often described as a burning sensation. Pain may appear a couple of hours after eating, which reflects the time it takes for food to reach that part of the intestine. Pain can sometimes occur after 5 hours, which provokes sleep disorders. Pain and discomfort temporarily disappear if you eat something or take antacids.
• Bleeding that turns the stools black and tar-like.
• Vomiting blood, which may be bright red or appear as small dark granules (which are small blood clots).

Sometimes a duodenal ulcer can spread right through the intestinal wall, then a perforated ulcer develops. The contents of the intestine can leak out through the hole, causing a serious infection in the abdomen. A ruptured ulcer (perforation) of the duodenum is a medical emergency.

Treatment of duodenal ulcer in adults

The attending physician can make a diagnosis simply by talking to the patient about the symptoms present. If an ulcer has developed and the person is not taking NSAIDs, H. pylori infection (helicobacteriosis) is most likely the cause. One of the diagnostic tests will be needed to confirm the diagnosis.

Diagnostics

Examination and tests are necessary to confirm the diagnosis. They include instrumental and laboratory tests.

• Endoscopy. If severe symptoms develop, the doctor may recommend an upper endoscopy or EGD to determine if the patient has an ulcer. In this procedure, the doctor inserts an endoscope (a small, lighted tube with a tiny camera) through the throat and into the stomach and duodenum to look for abnormalities.
• Tests for H. pylori. Tests for H. pylori are now widely used, and based on them, the doctor will select the appropriate treatment to reduce unpleasant symptoms and kill bacteria. The breath test is the easiest way to detect H. pylori. A doctor can also look for the germ through a blood or stool test, or by taking a sample during an upper endoscopy.
• visual tests. Less commonly, imaging tests such as x-rays and computed tomography are used to detect ulcers. The patient must drink a special fluid that coats the digestive tract and makes the ulcers more visible to the imaging machines.

Modern treatments

If an intestinal ulcer is bleeding, your doctor can stop the bleeding during an endoscopy procedure by injecting some medicines into the tissue of the ulcer. The specialist may also use a clamp or cauterization (electrocoagulation) to close the defect and stop the bleeding.

If the duodenal ulcer is caused by H. pylori, the so-called “triple therapy” will be the traditional home treatment tactic. It involves taking two types of antibiotics to kill bacteria in the lumen, combined with medication to reduce the amount of acid produced by the stomach.

If no H. pylori infection is detected and the person has been taking anti-inflammatory drugs, it will be imperative to stop taking them (if possible) and start taking a medication that reduces stomach acid production.

Also, treatment is supplemented by taking antacids, diet and giving up bad habits.

For the treatment of duodenal ulcers at home, the following groups of drugs are used:

• proton pump inhibitors – drugs in this group reduce acidity, which allows the ulcer to heal faster;
• histamine receptor blockers (H2 blockers) – these drugs also reduce acid production and help in the healing of defects;
• antibiotics – these drugs kill bacteria, doctors use them to treat H. pylori;
• protective drugs: liquid dressing or astringents – these drugs cover the ulcer with a protective layer to prevent further damage by digestive acids and enzymes.

Prevention of duodenal ulcers in adults at home

A patient can prevent ulcers from forming or getting worse if:

• Talk to your doctor about choosing an alternative to NSAIDs (such as paracetamol) for pain relief
• Discuss protective measures with your doctor if you can’t stop taking NSAIDs;
• will choose the lowest effective dose of NSAIDs and will take it with food;
• quit smoking and drink alcohol moderately, or give up bad habits altogether.

Popular questions and answers

We asked questions regarding the treatment of duodenal ulcers, prescribing drugs general practitioner, endoscopist, head of the organizational and methodological office Lidia Golubenko.