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McKesson Clinical Reference Systems: Women's Health Advisor 2002.2
Illustration
Duodenal Ulcer
What is a duodenal ulcer?
A duodenal ulcer is a raw area or open sore in the lining of
the small intestine where the upper small intestine
(duodenum) connects to the stomach.
How does it occur?
A duodenal ulcer occurs when an area of the lining of the
intestine is eaten away by stomach acid and digestive
juices. The lining of the intestine is normally protected
from stomach acids. However, under certain conditions the
protection fails and ulcers can result.
The most common cause of duodenal ulcers is a type of
bacteria called Helicobacter pylori, also called H. pylori.
These bacteria cause about 90% of all duodenal ulcers.
Other common causes of ulcers include anti-inflammatory
medicines such as aspirin, ibuprofen, and naproxen. Stress
also appears to contribute to ulcers. This includes both
emotional stress and the sudden physical stress of a severe
illness or injury.
Nicotine, caffeine, and alcohol seem to increase the chances
that you will get an ulcer.
People with a family history of duodenal ulcers are more
likely to get ulcers. The problem is four times more common
in men than in women. Most cases of ulcers occur between
ages 40 and 50.
What are the symptoms?
Symptoms include:
- gnawing or burning abdominal pain, especially in the
middle of the upper abdomen
- pain that may get better with eating or taking antacids
- pain that may get worse a couple hours after meals or
sometimes may be worse before meals
- pain that awakens you during the night.
If an ulcer is bleeding, you may have:
- vomit containing bright red blood or digested blood that
looks like brown coffee grounds
- black, tarry bowel movements.
How is it diagnosed?
Your health care provider will review your symptoms, ask
about your medical history, and examine you. You may have
one or more of these tests:
- an upper GI x-ray (for this test you swallow liquid
barium, which may allow your health care provider to see
the ulcer on an x-ray)
- blood tests to look for H. pylori bacteria
- tests of a sample of your bowel movement to check for
blood (which might come from a bleeding ulcer)
- a blood test for anemia (which may be sign of internal
bleeding)
- an endoscopy, which allows your provider to see an ulcer
with a thin flexible tube and tiny camera inserted
through your mouth down into your upper digestive tract
- a biopsy, which involves taking a piece of tissue during
an endoscopy and sending it to the lab for tests (this is
another way to test for H. pylori).
How is it treated?
The goals of treatment are pain relief, healing of the
ulcer, and prevention of complications. Treatment can also
help prevent recurrence of the ulcer.
Your health care provider may prescribe:
- antibiotics to treat H. pylori
- antacids
- medicine to reduce the amount of acid your stomach makes
- sucralfate, a medicine that forms a protective barrier
over the site of the ulcer to help it heal.
You will probably take the antibiotics for 1 to 2 weeks.
You may take medicine to decrease acid for at least 6 weeks.
Sometimes medicine needs to be taken for 6 to 12 months to
prevent new ulcers.
Because stress can contribute to the development of duodenal
ulcers, you may need to make changes in your lifestyle (see
"How can I take care of myself?").
How long will the effects last?
Duodenal ulcers respond well to treatment but they can
recur. You can help reduce the chance that an ulcer will
recur by taking your medicines.
About 25% of people with duodenal ulcers develop
complications. Possible complications of untreated ulcers
are:
- hemorrhage (massive bleeding)
- perforation (a hole through the intestinal wall produced
by an ulcer)
- obstruction (ulcer scarring that prevents passage of
food).
These complications may require surgery.
How can I take care of myself?
- Follow the full treatment prescribed by your health care
provider. Keep your follow-up appointments.
- Do not smoke or use other tobacco products.
- Do not drink alcohol.
- Do not drink strong nonherbal tea, caffeinated or
decaffeinated coffee, or colas.
- Avoid drugs that cause stomach inflammation, such as
aspirin, ibuprofen, and naproxen. (Ask your provider if
you can use acetaminophen for pain instead.)
- You may want to make other lifestyle changes such as:
- Eat healthy meals. Several small meals may be better
than 2 or 3 large ones.
- Learn how to manage stress. Seek professional help
for dealing with events that cause anxiety and stress.
- Get plenty of rest.
- Exercise as recommended by your health care provider.
- If you keep having symptoms or your symptoms get worse,
tell your health care provider.
How can I help prevent duodenal ulcers?
- Follow your health care provider's treatment plan and
keep your follow-up appointments.
- Change your lifestyle in ways that might help prevent
ulcers.
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