An ulcer in the gastrointestinal tract is a deep defect in the mucous membrane. It should not be confused with a tumor, which is a proliferation of tissue.
A duodenal ulcer (also known as a duodenal ulcer) is therefore a deep ulcer of the duodenum. An erosion, on the other hand, is a mucosal defect that is only superficial.
Illustration of the gastrointestinal tract including the duodenum © FGWDesign | AdobeStock
In over 90% of cases, the cause of a duodenal ulcer is an infection of the stomach with the bacterium Helicobacter pylori (HP). This leads to chronic inflammation of the stomach. As a result, fewer mucous membrane-protecting factors (so-called prostaglandins) are produced. At the same time, the production of stomach acid increases. This then attacks the mucous membrane of the duodenum, among other things.
Genetic factors also play a role here. For example, people with blood group 0 and the surface marker HLA-B5 are particularly frequently affected by duodenal ulcers. Smoking can also promote the development of a duodenal ulcer.
One of the most common causes of a duodenal ulcer without evidence of HP (so-called HP-negative ulcer) is the use of
- certain painkillers such as ASS (aspirin) or non-steroidal
- non-steroidal anti-inflammatory drugs (e.g. diclofenac, ibuprofen, indomethacin).
These drugs inhibit the factors that protect the mucous membrane.
Possible location of duodenal ulcers © Henrie | AdobeStock
The risk of duodenal ulcers is particularly high in patients with an HP infection of the stomach who are also taking such medications. If a cortisone preparation is also taken, the risk of a duodenal ulcer increases by a factor of 15.
Stress can also lead to "hyperacidity" of the stomach and provoke a duodenal ulcer. This is frequently seen in intensive care units in patients with
- severe injuries,
- extensive skin burns or complicated
- complicated serious operations.
In rare cases, there is a tumor disease (Zollinger-Ellison syndrome) or a metabolic disease (hyperparathyroidism). These can lead to excessive acid formation and thus promote the development of duodenal ulcers.
A duodenal ulcer can be characterized by pain in the upper abdomen, which improves with food intake (the acid is used up for digestion). However, patients also complain of
- nausea,
- vomiting,
- a feeling of pressure and fullness.
In the case of a duodenal ulcer under pain medication, upper abdominal pain may be completely absent. The ulcer then only becomes noticeable due to the bleeding.
Possible complications of a duodenal ulcer
- A duodenal ulcer can reach a blood vessel and lead to bleeding. This can lead to vomiting blood (hematemesis) or the passing of pitch-black stool ("tarry stool" or melena). Sometimes the blood loss is gradual and manifests itself inanemia.
- If the duodenal ulcer breaks through the muscle layer, a so-called perforation occurs. The patient complains of sudden, severe pain. Immediate surgery is required. An X-ray of the abdominal cavity shows free air in the abdominal cavity.
- If the duodenal ulcer breaks into another organ (penetration), e.g. into the pancreas, this leads to an inflammatory reaction in the affected organ.
Late effects of duodenal ulcers
Due to scarring, the passage of food may be obstructed (gastric outlet stenosis). Scars occur in approx. 2 % of patients with ulcer disease.
The diagnosis can be easily made by gastroscopy. At the same time, tissue samples can be taken to determine whether an infection with Helicobacter is present.
No surgical incisions are necessary for a gastroscopy © bilderzwerg | AdobeStock
In the case of HP-positive duodenal ulcers, the bacterium is treated with antibiotics. The patient is given a gastric acid blocker (proton pump inhibitor PPI).
In the case of HP-negative duodenal ulcers, the triggers such as pain medication should be discontinued or replaced with stomach-friendly preparations. A PPI is also administered.
In very rare cases, a duodenal ulcer may require surgery, for example if
- bleeding occurs that cannot be stopped during gastroscopy or
- if a perforation has occurred.
