Giant duodenal ulcers (GDUs) are characterized by their unusual appearance on barium roentgenogram and by their high morbidity and mortality. Brdiczka1 first described these exceptionally large ulcers, which are often missed on barium studies because of their nodular appearing edges.
H pylori eradication is essential; antibiotics like amoxicillin, famotidine, or omeprazole along with acid (histamine) receptor antagonists may help.
Symptoms
A duodenal ulcer is a painful sore in the lining of your stomach or first part of your small intestine (the duodenum). It’s one of many types of peptic ulcers, which occur when the protective mucus lining is eroded by the digestive acid that normally protects the lining. Most of the time the symptom is pain in the area of the ulcer, but it can spread to other parts of your stomach or intestines. Duodenal ulcers are most often caused by an overgrowth of the bacteria Helicobacter pylori (H. pylori), but other factors can also lead to them, including overusing nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen.
Stomach pain is the most common symptom. It is usually present from midmorning to lunch or dinnertime and may last two to three hours or more. The pain is typically worse after meals and relieved by eating or taking an antacid. It can be accompanied by nausea and vomiting. If it persists or is accompanied by fever, weight loss or blood in your vomit, seek medical help right away.
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Other symptoms of a duodenal ulcer can include a feeling of bloating after eating and a loss of appetite. Sometimes, a duodenal ulcer can perforate into the stomach or intestines, which can lead to complications such as peritonitis or hematemesis (blood in your vomit).
Several tests can help diagnose a duodenal ulcer. The most important test is a gastric endoscopy, which lets doctors see the lining of your stomach and duodenum. A doctor can also use a special tool called an EGD scope to remove some tissue for further testing. A biopsy from this tissue can help diagnose the condition if H. pylori is found, which is the most common cause of ulcers in Western countries.
Another type of test to diagnose a duodenal ulcer is a breath test that detects hydrogen, a chemical in your body that’s produced when you digest foods. If the test is positive, it means you have high levels of H. pylori in your body and it’s likely the bacterium is causing your ulcer.
Diagnosis
Duodenal ulcers are a type of peptic ulcer. Peptic ulcers develop when the protective mucus lining of the stomach or small intestine is worn away. These ulcers are found in 5-10% of people in the Western world and are usually caused by Helicobacter pylori (H. pylori) bacteria or overusing nonsteroidal anti-inflammatory drugs (NSAIDs).
To diagnose a duodenal ulcer, your doctor will take a history of symptoms, examine you and perform a variety of tests. These tests can include blood work and abdominal X-rays or CT scans. These imaging studies can show your doctor whether you have a perforated ulcer, and will help your doctor determine what the cause of your ulcer is.
You may also have a blood test to check for H. pylori infection, or you might have to drink a liquid that coats your digestive tract and makes ulcers easier to see on a barium X-ray or CT scan. Your doctor might also do a gastric endoscopy. During this procedure, your doctor might inject medication directly into your ulcer to treat it. They might also use a clamp or cauterization to seal the bleeding site or to burn off the excess tissue that’s producing acid.
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Bleeding from a duodenal ulcer can be slow and go unnoticed or it might happen more quickly and be life-threatening. The most serious complications include hemorrhage and perforation. Bleeding that isn’t treated right away can lead to severe anemia, a condition where you don’t have enough healthy red blood cells to carry oxygen throughout your body. Anemia can also lead to fatigue, shortness of breath with exercise and pale skin color.
Medications can treat most duodenal ulcers and prevent complications from developing. Your doctor might prescribe a proton pump inhibitor to reduce the amount of acid your stomach produces. Examples of these medicines are Prilosec, Prevacid and Nexium. Your doctor might also prescribe a histamine receptor blocker to reduce acid production. Examples of these medications are Tagamet, Pepcid and Zantac. Your doctor might also prescribe antibiotics to kill the H. pylori infection.
You should also avoid NSAIDs because these can make your ulcer worse. You should also eat a well-balanced diet and try to stop smoking. Smoking and some foods, such as fruit juices, spicy foods and fatty food, can increase the acid in your stomach. Your doctor might also advise you to avoid alcohol because it can worsen your symptoms.
Treatment
Duodenal ulcers are a type of peptic ulcer. They happen when the layer of mucus that lines your stomach or duodenum is damaged by bacteria, infection, certain medications or other substances. The most common symptom is pain in the upper abdomen. It usually comes and goes and may be worse after you eat or at night. It is sometimes relieved by eating or taking antacid tablets. The pain can sometimes cause a stinging or burning sensation and it may wake you from sleep. If the ulcer is bleeding, you will often have blood in your stool. The bleeding may range from a trickle to a life-threatening bleed.
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Many people can prevent ulcers from developing by making some simple lifestyle changes. For example, you should avoid smoking and heavy alcohol consumption. You should also eat smaller meals and try to eat three hours before going to bed. You should also take a non-steroidal anti-inflammatory medication (NSAID) only as directed and switch to other pain medication like acetaminophen if you have to use an NSAID.
A bacterial infection called Helicobacter pylori (H. pylori) is believed to be the cause of most duodenal ulcers. It is a bacterium that grows in the stomach and causes inflammation. It is believed to be the cause of about 90% of all peptic ulcers including duodenal ulcers.
In recent years it has been proven that H. pylori plays a central role in the genesis of peptic ulcers.1
A test to detect the presence of H. pylori is usually done. It can be detected by a breath test or with a sample of your stool. Treatment regimens typically include acid suppressing medications and antibiotics to eradicate the infection.
Prevention
Stomach acid and other digestive juices can cause ulcers, so avoiding foods that make your stomach acid worse and taking an antacid medicine may help. You should also try to lose weight if you are overweight, and limit your alcohol intake.
You should call your doctor right away if you have a sharp pain in your abdomen that doesn’t go away, or blood in your vomit or stools (feces). These symptoms are signs of a dangerous condition called perforation of the duodenum, which requires immediate treatment.
Peptic ulcers are sores that occur in the lining of your stomach or first part of your small intestine (duodenum). Most often, they happen because of an infection with bacteria called Helicobacter pylori. Other things that can cause them include stress, spicy foods, and the long-term use of certain pain medicines like aspirin and ibuprofen.
Your doctor will review your symptoms and do tests to see if you have an ulcer. They may do a test of your breath, stool, or blood to look for the H. pylori bacteria, or they may use a long, flexible tube with a camera on the end of it to look inside your throat and stomach for signs of an ulcer (an upper endoscopy).
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They may do a test of your blood to look for signs of anemia, such as low red blood cell count. They might also do a CT scan or an ultrasound to look for signs of inflammation of your stomach or duodenum.
Once your doctor determines that you have a peptic ulcer, they’ll create a care plan for you that may include lifestyle changes and medications. For example, they might recommend that you avoid any foods or drinks that make your symptoms worse and that you quit smoking. They might also suggest that you take a combination of antibiotics and a medication to reduce your stomach’s production of acid.
Once your peptic ulcer is treated, you can prevent it from returning. Wash your hands regularly and avoid eating foods that trigger your ulcer, such as tomatoes, chocolate, and fatty or spicy foods. You should also limit your alcohol intake and stop using NSAIDs unless you are advised by your doctor to do so.
