Duodenal ulcer is an injured spot on the duodenal membrane, i.e. a tube that leads from the stomach to the other parts of the digestive tract. The diameter of an ulcer is usually smaller than 15 mm, and is caused by erosion of the surface of the duodenum with an acid, secreting from the stomach. The pain in the duodenal ulcer is the result of the action of gastric acid on the exposed surface of an ulcer. Duodenal ulcer belongs to the group of peptic ulcers, as well as the stomach ulcer.
Patients occasionally feel the pain in the abdominal cavity; they are typically spasmodic and are usually restricted to a small area in the upper abdominal cavity. In some cases, when the ulcer has affected the back wall of the duodenum, the patients will feel the back pain. Pains – which resemble “hunger pains” – usually occur several hours after meals. Generally, relaxation can be achieved with antacid tablets (they neutralize stomach acidity), a glass of milk or two or three biscuits.
Sometimes, after a meal, the patient feels swelling and vomiting is possible.
Duodenal ulcer affects more than 10% of the population in developed countries. Disease is four times more common in men, and most common in young people and those in the middle ages.
Particularly sensitive are passionate smokers, as well as those who normally produce large amounts of gastric acid. The chances of getting duodenal ulcer are increased if you frequently take painkillers containing aspirin or similar substances, antireumatics or corticosteroids.
Although the duodenal ulcer is painful, there is no great risk of severe or permanent damage due to complications, and the untreated ulcers often disappears by itself. In some cases an ulcer may begin to bleed; no matter how small it is, long-lasting bleeding can cause sideropenic anemia. Because of the sudden and severe bleeding, a patient can vomit blood or discharge a black stool. Losing large amounts of blood is an urgent case which requires immediate medical attention. A further possible complication is the permanent generation of scars (as a result of an ulcer), which leads to narrowing of the entrance to the duodenum (see pyloric stenosis article).
In a small number of cases (perhaps 1 to 2% of the total number) an ulcer will try to erode the wall of the duodenum towards the abdominal cavity which can cause peritonitis if no surgery is performed immediately. Perforation causes sudden and intense pain, followed by shock and collapse. Such emergencies require immediate medical intervention.
What to do?
If you think you have a duodenal ulcer, try applying the recommended self-help measures. If the symptoms do not disappear within two weeks, go to a doctor who will send you to diagnostic tests (which are the same as in a stomach ulcer).
Self-help: if you smoke, quit smoking. Reduce the amount of alcohol, especially wine and strong drinks. You can generally eat what you want, but eat slowly and rest for half an hour after a meal. It is also advisable to take several small meals at regular intervals during the day and not just two or three full courses; the food in stomach neutralizes the gastric acid that causes pain. If you miss meals or eat irregularly, the symptoms will probably be worse.
It will also help you take tablets of antacids or other medicines regularly. In some cases these simple measures will be sufficient to cure an ulcer without the need for further therapy.
Professional help: at first, your doctor may just give you an advice about nutrition and eating habits and prescribe more suitable antacids. If this does not help, an alternative is the medicine that reduces the production of gastric acid. When taking such medicines, it is important to strictly follow the doctor’s instructions: if you stop taking the medicine suddenly, an ulcer may come back.
Duodenal ulcer rarely requires surgery; operations are only performed in rare cases when an ulcer is not responding to long-term therapy or in case of complications. There are several types of operations, but all of them have the same goal – reducing the amount of produced gastric acid. This can be achieved by removing the part of the stomach or the so-called vagotomy. Such operations are safe and are usually successful, although occasional uncomfortable consequences such as drowsiness, trembling and sweating occur shortly after meals, weight loss with diarrhea, anemia, or lack of vitamin D. But sometimes, medications can solve these problems.