Ulcers are caused by stomach acid and gastric juices that damage tissue throughout the digestive tract. The general term "peptic ulcer" applies to ulcers occurring in the stomach or duodenum (the beginning area of the small intestine). Duodenal ulcers are more prevalent among men and generally present between the ages of 30 to 50 years old.
The Facts
Duodenal ulcers are areas of the duodenum that have been eroded or where there are sores in the wall of the lining of the mucous membrane. The ulcers can be caused by acid erosion, long-term use of NSAIDs like ibuprofen or an infection of a bacteria called Helicobacter pylori. Research has proven that people who suffer from ulcers generally have an imbalance of acid and pepsin combined with a weakened ability for the body to protect itself.
Additional Considerations
Research has also shown that while lifestyle choices do not cause ulcers, the following habits tend to weaken the protective lining in the stomach; increasing the chances for developing an ulcer:
• Using NSAIDs like naproxen, ibuprofen, Celebrex
• Regular use of alcohol
• Stress (both physical and emotional)
• Caffeine intake
• Smoking
Symptoms
Your symptoms vary in both type and severity. Many patients report experiencing mild indigestion, pain or a burning sensation in the abdomen between the navel and the breastbone, nausea, vomiting, appetite loss and weight loss. Often described as a burning, gnawing sensation, the pain often occurs a few hours after eating and it frequently worsens at night. More serious complications include bleeding, vomiting blood and blood in the stool. Should you experience vomiting blood (or a dark substance similar to coffee grounds), you should visit the emergency room as soon as possible.
Diagnosis
The most common tests are: upper GI series (in which you first drink special liquid to add contrast and then receive x-rays) and endoscopy (you are sedated and your doctor threads a small tube with a camera down your mouth and into your stomach). If your doctor determines that you do have an ulcer, he will also test to determine whether H pylori bacteria are causing your condition. This is often performed by blood test, breath test (after drinking a special liquid) or testing actual tissues extracted during an endoscopy.
Treatment
If your duodenal ulcer is a result of h pylori you will likely be treated with a combination of antibiotics and possibly a proton-pump inhibitor, like omeprazole (Prilosec) or esomeprazole (Nexium). Common antibiotics include amoxicillin, clarithromycin, levofloxacin, tetracycline and metronidazole.
If h pylori was not the cause of your ulcer, your doctor will likely begin by reducing your risk factors. H2 blockers like ranitidine, famotodine, or cimetidine are often prescribed as part of the course of treatment. Other options include proton-pump inhibitors (like those listed above). Both types of drugs reduce the output of acid.
Your doctor may also consider treatment with a medication to strengthen the lining of your gastrointestinal tract (like sucralfate or misoprostol).
Complications
• Vomiting blood or having dark, tarry stools may be a sign of gastrointestinal bleeding. This may result in anemia or more serious complications, often requiring hospitalization, infusion of liquids and possibly a blood transfusion.
• Sudden, severe pain in the abdomen could indicate a perforation. This creates a hole in your duodenum through which gastric contents spill into your abdominal cavity. The risk of infection (acute peritonitis) is quite high and emergency surgery is necessary to repair the damage.
• Ulcers can cause scar tissue which obstructs the movement of food through the GI tract. Vomiting and pain in the abdomen along with weight loss and loss of appetite could signal a possible obstruction which will likely require surgery to correct.
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