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About duodenal ulcer

What is duodenal ulcer?

Though ulcers often heal on their own, you shouldn't ignore their warning signs. If not properly treated, ulcers can lead to serious health problems, including:

  • Bleeding
  • Perforation (a hole through the wall of the stomach)
  • Gastric outlet obstruction from swelling or scarring that blocks the passageway leading from the stomach to the small intestine

Taking NSAIDs can lead to an ulcer without any warning. The risk is especially concerning for the elderly and for those with a prior history of having peptic ulcer disease.

What are the symptoms for duodenal ulcer?

One way of telling if you may have a gastric or duodenal ulcer is to figure out where and when your symptoms occur. For some, the time between meals aggravates an ulcer. For others, eating may be a trigger for the pain.

The exact location of the pain doesn’t always match up with the location of the ulcer, though. Sometimes the pain is referred. This means that a person may have pain in a location away from the actual ulcer.

Other symptoms can include:

According to digestive specialists, most ulcer symptoms are related to bleeding.

But nearly 75 percent of people who have gastric or duodenal ulcers don’t have any symptoms. In fact, these ulcers rarely cause severe symptoms.

If severe symptoms do occur, they can include:

  • blood in your stool, or stool that appears  or tarry
  • difficulty breathing
  • Feeling faint or losing consciousness
  • Vomiting blood
  • shortness of breath with activity
  • Fatigue

Seek emergency medical attention if you feel Stomach pain and any of the above symptoms.

What are the causes for duodenal ulcer?

Helicobacter pylori bacteria (H. pylori)

H. pylori is the most common cause of gastric and duodenal ulcers. This bacterium affects the mucus that protects your stomach and small intestine, allowing for stomach acid to damage the lining.

An estimated 30 to 40 percent of U.S. people are infected with H. pylori.

It’s unclear exactly how this bacterium spreads, but researchers believe it’s mostly through unclean food, water, and eating utensils. People who carry H. pylori can also spread it through direct contact with saliva.

Many people get this bacterial infection as a child, but it rarely develops into a peptic ulcer. In fact, most people don’t see symptoms until they’re older — if at all.

Medications

People who use or rely on nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, and naproxen, are more likely to develop peptic ulcers. In fact, after H. pylori, NSAID use is the other major cause of peptic ulcers.

NSAIDs can irritate and damage your stomach and intestinal lining. Acetaminophen (Tylenol) isn’t an NSAID, so it’s often recommended for people who can’t take NSAIDs due to ulcers or other digestive conditions.

Other conditions

A rare condition known as Zollinger-Ellison syndrome causes the development of both cancerous and noncancerous tumors. These tumors release hormones that cause extremely high levels of stomach acid that can lead to gastric and duodenal ulcers.

These tumors most often develop in the pancreas and duodenum, but can occur in other places throughout the body.

What are the treatments for duodenal ulcer?

Treatment for peptic ulcers depends on the cause. Usually treatment will involve killing the H. pylori bacterium if present, eliminating or reducing use of NSAIDs if possible, and helping your ulcer to heal with medication.

Medications can include:

  • Antibiotic medications to kill H. pylori. If H. pylori is found in your digestive tract, your doctor may recommend a combination of antibiotics to kill the bacterium. These may include amoxicillin (Amoxil), clarithromycin (Biaxin), metronidazole (Flagyl), tinidazole (Tindamax), tetracycline and levofloxacin.

    The antibiotics used will be determined by where you live and current antibiotic resistance rates. You'll likely need to take antibiotics for two weeks, as well as additional medications to reduce stomach acid, including a proton pump inhibitor and possibly bismuth subsalicylate (Pepto-Bismol).

  • Medications that block acid production and promote healing. Proton pump inhibitors — also called PPIs — reduce stomach acid by blocking the action of the parts of cells that produce acid. These drugs include the prescription and over-the-counter medications omeprazole (Prilosec), lansoprazole (Prevacid), rabeprazole (Aciphex), esomeprazole (Nexium) and pantoprazole (Protonix).

    Long-term use of proton pump inhibitors, particularly at high doses, may increase your risk of hip, wrist and spine fracture. Ask your doctor whether a calcium supplement may reduce this risk.

  • Medications to reduce acid production. Acid blockers — also called histamine (H-2) blockers — reduce the amount of stomach acid released into your digestive tract, which relieves ulcer pain and encourages healing.

    Available by prescription or over the counter, acid blockers include the medications famotidine (Pepcid AC), cimetidine (Tagamet HB) and nizatidine (Axid AR).

  • Antacids that neutralize stomach acid. Your doctor may include an antacid in your drug regimen. Antacids neutralize existing stomach acid and can provide rapid pain relief. Side effects can include constipation or diarrhea, depending on the main ingredients.

    Antacids can provide symptom relief but generally aren't used to heal your ulcer.

  • Medications that protect the lining of your stomach and small intestine. In some cases, your doctor may prescribe medications called cytoprotective agents that help protect the tissues that line your stomach and small intestine.

    Options include the prescription medications sucralfate (Carafate) and misoprostol (Cytotec).

Follow-up after initial treatment

Treatment for peptic ulcers is often successful, leading to ulcer healing. But if your symptoms are severe or if they continue despite treatment, your doctor may recommend endoscopy to rule out other possible causes for your symptoms.

If an ulcer is detected during endoscopy, your doctor may recommend another endoscopy after your treatment to make sure your ulcer has healed. Ask your doctor whether you should undergo follow-up tests after your treatment.

Ulcers that fail to heal

Peptic ulcers that don't heal with treatment are called refractory ulcers. There are many reasons why an ulcer may fail to heal, including:

  • Not taking medications according to directions
  • The fact that some types of H. pylori are resistant to antibiotics
  • Regular use of tobacco
  • Regular use of pain relievers — such as NSAIDs — that increase the risk of ulcers

Less often, refractory ulcers may be a result of:

  • Extreme overproduction of stomach acid, such as occurs in Zollinger-Ellison syndrome
  • An infection other than H. pylori
  • Stomach cancer
  • Other diseases that may cause ulcerlike sores in the stomach and small intestine, such as Crohn's disease

Treatment for refractory ulcers generally involves eliminating factors that may interfere with healing, along with using different antibiotics.

If you have a serious complication from an ulcer, such as acute bleeding or a perforation, you may require surgery. However, surgery is needed far less often now than previously because of the many effective medications available.

What are the risk factors for duodenal ulcer?

While doctors often recommend NSAIDs for health conditions such as arthritis or joint inflammation, NSAIDs can increase your risk for developing peptic ulcers.

Additional medications that may increase your risk for gastric, duodenal, and bleeding ulcers include:

  • osteoporosis treatments such as alendronate (Fosamax) and risedronate (Actonel)
  • anticoagulants, like warfarin (Coumadin) or clopidogrel (Plavix)
  • selective serotonin reuptake inhibitors (SSRIs)
  • certain chemotherapy medications

Other risk factors known to increase your risk for developing gastric and duodenal ulcers include:

  • being 70 years old or older
  • drinking alcohol
  • having a history of peptic ulcers
  • smoking
  • severe injury or physical trauma

It’s a myth that spicy foods can increase your risk for ulcers or cause them. But certain foods can irritate the stomach further in certain individuals.

Is there a cure/medications for duodenal ulcer?

Duodenal ulcer is a type of peptic ulcer that result in a sore on the inside lining and upper portion of the duodenum (first part of the small intestine. This user may result in stomach pain, bloating, intolerance to fatty food, and nauseous. However, it is curable through medication and care. Still, before medication, the doctor may diagnose you with endoscopy, X-rays, and lab tests to check the cause and seriousness of the matter and provide treatment accordingly.

The cure and treatment for the duodenal ulcer:

  • Medications that promote healing and block acid production: Proton pump inhibitors (PPI) block the parts of the cells that produce acids; thus it reduces inflammation in the duodenum. Prilosec, Prevacid, Aciphex, Protonix, and Nexium are some drugs prescribed by doctors to cure these ulcers.
  • Acid production reducing medications: Acid blockers or histamine blockers reduce acid production and revies pain. Peptide AC, Axid AR, and Tagamet HB are some over-the-counter drugs used to reduce acid production in digestive tracts and promote healing.
  • Antacid that neutralizes stomach acid: The constant inflammatory actions caused by the ulcers can be relieved by antacids. The acid neutralizes existing stomach acid and can give quick help with discomfort. However, it can result in some side effects like diarrhea and nauseous.


Medications like Carafate and Cytotec can strengthen the lining of the intestine and stomach.

Conditions
Painful open sores,Painful stomach lining,Bleeding,Obstruction,Perforation
Drugs
Medicine like Carafate,Cytotec, Prilosec Prevacid,Protonix,Acid-suppressing medications - proton pump inhibitor (lowest dose),Surgery
Symptoms
Vomiting or blood vomiting,Dark blood in stools,Trouble breathing,Appetite changes,Unexpected weight loss

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