Duodenal ulcers

Duodenal Ulcers

Duodenal ulcers are a type of peptic ulcer that occur in the first part of the small intestine, known as the duodenum. They are a common gastrointestinal condition characterized by the formation of open sores on the inner lining of the duodenum.

Etiology

The primary causes of duodenal ulcers include:

• Helicobacter pylori infection: This bacterium is found in the gastric mucosa and is a major cause of duodenal ulcers. It disrupts the mucosal barrier and increases gastric acid secretion.
• Nonsteroidal anti-inflammatory drugs (NSAIDs): Chronic use of NSAIDs can impair the mucosal defenses and lead to ulcer formation.
• Hypersecretion of gastric acid: Conditions such as Zollinger-Ellison syndrome can lead to excessive acid production, contributing to ulcer development.

Pathophysiology

Duodenal ulcers result from an imbalance between aggressive factors, such as gastric acid and pepsin, and defensive factors, such as the mucosal barrier and bicarbonate secretion. The presence of H. pylori and NSAID use can exacerbate this imbalance, leading to mucosal damage and ulceration.

Clinical Presentation

Patients with duodenal ulcers may present with:

• Epigastric pain: Typically described as a burning or gnawing sensation, often occurring 2-3 hours after meals and relieved by food or antacids.
• Nocturnal pain: Pain that awakens the patient at night is common.
• Nausea and vomiting: These symptoms may occur, especially if there is gastric outlet obstruction.
• Bleeding: Ulcers can erode into blood vessels, leading to hematemesis or melena.

Diagnosis

The diagnosis of duodenal ulcers can be confirmed through:

• Endoscopy: Direct visualization of the ulcer and biopsy for H. pylori testing.
• Urea breath test: Non-invasive test for H. pylori infection.
• Stool antigen test: Another non-invasive method to detect H. pylori.

Treatment

The management of duodenal ulcers involves:

• Eradication of H. pylori: A combination of antibiotics (such as amoxicillin and clarithromycin) and a proton pump inhibitor (PPI) is used.
• Acid suppression: PPIs or H2 receptor antagonists are used to reduce gastric acid secretion and promote healing.
• Discontinuation of NSAIDs: If possible, NSAIDs should be stopped or replaced with alternative medications.

Complications

Complications of duodenal ulcers include:

• Perforation (medical): A full-thickness ulcer can lead to perforation and peritonitis.
• Gastrointestinal bleeding: Ulcers can cause significant bleeding, leading to anemia or shock.
• Gastric outlet obstruction: Chronic inflammation and scarring can obstruct the pyloric channel.

Prevention

Preventive measures include:

• Avoidance of NSAIDs: Use alternative pain management strategies when possible.
• H. pylori eradication: Screening and treatment of H. pylori infection in high-risk populations.
• Lifestyle modifications: Reducing alcohol consumption and smoking cessation.

See Also

• Gastric ulcer
• Peptic ulcer disease
• Gastroesophageal reflux disease

References

• Marshall, B. J., & Warren, J. R. (1984). Unidentified curved bacilli in the stomach of patients with gastritis and peptic ulceration. The Lancet, 323(8390), 1311-1315.
• Soll, A. H. (1990). Pathogenesis of peptic ulcer and implications for therapy. The New England Journal of Medicine, 322(13), 909-916.