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Duodenal Ulcer is a classification of Peptic Ulcer. Ulcers are located in the duodenum that is acidic and extremely painful to most of the patients. The wikipedia says it is as much as 80% of the cases of peptic ulcer that is associated with H. Pylori (a spiral shaped bacterium that lives in an extremely acidic environment). Ulcers can also be worsened with the use of Aspirin and other NSAIDs (Non-steroidal Anti-inflammatory drug) such as Ibuprofen and Mefenamic acid.

  Signs and Symptoms

 Abdominal pain, bloating and abdominal fullness, waterbrush (rush of saliva), nausea and vomiting, loss of apetite, weight loss, hematemesis (vomiting of blood), and melena. A history of hearturn, gastroesophageal reflux disease and use of certain forms of medications such as NSAIDs can lead into peptic ulcer.

Complications

Gastrointestinal bleeding–can be life threatening if not managed well.
Perforation — leads to peritonitis and pancreatitis.
Penetration — ulcer continues into adjacent organs such as the liver and pancreas.
Scarring and swelling due to ulcers causes narrowing of the duodenum which leads into extreme vomiting.
Pyloric Stenosis

Causes

Tobacco smoking, blood group, and spices are said to be minor causatives in the development of peptic ulcers.
The major causative factor is the chronic inflammation due to Helicobacter Pylori that colonizes (and settles) in the antral mucosa.  The immune system cannot seem to clear the infection at all. The bacterium invades the gastric mucosa that causes gastritis that results to the defect in gastrin production. The gastric acid secretion increases leading to the erosion of the mucosa that leads into ulcer.

Stress can cause Ulcers?

As we have learned, only 80% of the ulcer cases are said to be caused by the H. pylori bacteria. So what about the remaining 20% of the cases? According to research of the Academy of Behavioral Medicine, ulcers are not purely an infectious disease but rather, psychological factors do play a significant role in developing the disease. Since H. pylori thrives in an acidic environment and stress can develop a significant amount of acid in the stomach, therefore, stress can be associated with the development of ulcers in the gastric mucosa. Stress is considered to be a cofactor together with H. pylori in developing ulcers.

Diagnostic Tests

⌐ Esophagogastroduodenoscopy (EGD), a form of endoscopy is carried out to patients suspected with peptic ulcers. By direct visual identification, the location of ulcer and its severity can be described. However, if no ulcerations can be found, other alternative tests can be used such as the following:

To test the presence of H. pylori:
⌐ Breath testing
⌐ Direct culture from EGD biopsy specimen
⌐ Direct detection of a urease activity in a biopsy specimen
⌐ Measurement of antibody levels in blood.

Treatment

For younger patients - antacids, H2 blockers, bismuth compounds
Patients who are taking NSAIDs are given Misoprostol to prevent ulcers.
When H. pylori is present, the combination of 2 antibiotics is good — Clarithromycin, Amoxicillin, Tetracycline, Metronidazole, and 1 proton pump inhibitor (Omeprazole).