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There are two main variants of peptic ulcer disease; duodenal ulcer is the commoner of the two main variants of peptic ulcer, the other one is stomach ulcer. An ulcer simply means a wound or a distortion in the contiguity of a surface, it could be on the outer skin or on the inside lining of the hollow organs in the body. Examples are skin ulcers, diabetic foot ulcer, stomach ulcer, duodenum ulcer etc.
There are two main variants of peptic ulcer disease; duodenal ulcer is the commoner of the two main variants of peptic ulcer, the other one is stomach ulcer. An ulcer simply means a wound or a distortion in the contiguity of a surface, it could be on the outer skin or on the inside lining of the hollow organs in the body. Examples are skin ulcers, diabetic foot ulcer, stomach ulcer, duodenum ulcer etc.
Duodenal ulcer implies a wound on the lining of the first part of the small intestine – the duodenum.
Like the other ulcers, duodenum ulcer elicits unpalatable symptoms and
signs that could be most discomforting to the affected as enumerated
below.
Stomach and upper intestine
The food journey in our body involves passage of food from the mouth down to the oesophagus (the food pipe) into the stomach. The stomach makes acid which helps to digest food. After being mixed in the stomach, food passes into the duodenum, then to other segment of the small intestine whence unto the large intestine to the anus. Of course while the journey occurs, the food is subject to all kinds of degradations – digestion, churning and absorption.
In the duodenum and the rest of the small intestine, food mixes with
enzymes (chemicals). The enzymes come from the pancreas and from cells
lining the intestine. The enzymes break down (digest) the food which is
absorbed into the body. It is the undigested food that is then passed
out as faeces (stool).
Peptic inflammation
Peptic inflammation is caused by the stomach acid in the absence of adequate (or defective) natural protection for the inner lining of the stomach. Inflammation can occur in the stomach, the duodenum (as acid flows in with food), or (as discussed in the preceding editions of this column) the lower oesophagus if some acid splashes back up to cause 'reflux oesophagitis' or heartburn disease.
The duodenum
The duodenum is the most common site for a peptic ulcer to occur. It is the immediate continuation of the stomach, where the stomach or food pouch leads to. It is the first part of the intestine and it is regularly bathed with acid “flowing down from the stomach to the duodenum.
Although, it might look logical to think that a duodenal ulcer is caused by too much acid coming from the stomach. This belief is not particularly true. The reality is that most people with a duodenal ulcer actually make a normal amount of acid.
The problem is the way the lining of the duodenum copes with the acid. The duodenum makes chemicals and mucus which covers the surface and protects the tissues from the acid. An ulcer occurs if the acid breaks through this protection. The causes of duodenal ulcers include the following.
Peptic inflammation
Peptic inflammation is caused by the stomach acid in the absence of adequate (or defective) natural protection for the inner lining of the stomach. Inflammation can occur in the stomach, the duodenum (as acid flows in with food), or (as discussed in the preceding editions of this column) the lower oesophagus if some acid splashes back up to cause 'reflux oesophagitis' or heartburn disease.
The duodenum
The duodenum is the most common site for a peptic ulcer to occur. It is the immediate continuation of the stomach, where the stomach or food pouch leads to. It is the first part of the intestine and it is regularly bathed with acid “flowing down from the stomach to the duodenum.
Although, it might look logical to think that a duodenal ulcer is caused by too much acid coming from the stomach. This belief is not particularly true. The reality is that most people with a duodenal ulcer actually make a normal amount of acid.
The problem is the way the lining of the duodenum copes with the acid. The duodenum makes chemicals and mucus which covers the surface and protects the tissues from the acid. An ulcer occurs if the acid breaks through this protection. The causes of duodenal ulcers include the following.
Infection by H. pylori
The bacteria Helicobacter pylori (H. pylori) cause about 19 in 20 (95%) cases of duodenum ulcer. This bacterium affects the lining of the duodenum in some way which allows the acid to cause inflammation and ulcers.
The bacteria Helicobacter pylori (H. pylori) cause about 19 in 20 (95%) cases of duodenum ulcer. This bacterium affects the lining of the duodenum in some way which allows the acid to cause inflammation and ulcers.
Anti-inflammatory/Analgesic medicines
This group of medicines which many people take for arthritis, fever, muscular pains, headache etc may lead to the development of frank ulcer etc. Examples are aspirin, ibuprofen, and diclofenac etc. These medicines sometimes affect the lining of the duodenum and allow acid to cause an ulcer.
This group of medicines which many people take for arthritis, fever, muscular pains, headache etc may lead to the development of frank ulcer etc. Examples are aspirin, ibuprofen, and diclofenac etc. These medicines sometimes affect the lining of the duodenum and allow acid to cause an ulcer.
Other causes
These are rare. An example is Zollinger-Ellison syndrome. In this rare condition, much more acid than usual is made by the stomach due to excessive stimulation of acid production by the acid-secreting cells in the stomach and in unusual places along the gut.
Other factors such as smoking, stress, and drinking heavily may possibly increase the risk of having a duodenal ulcer and could also aggravate the condition.
These are rare. An example is Zollinger-Ellison syndrome. In this rare condition, much more acid than usual is made by the stomach due to excessive stimulation of acid production by the acid-secreting cells in the stomach and in unusual places along the gut.
Other factors such as smoking, stress, and drinking heavily may possibly increase the risk of having a duodenal ulcer and could also aggravate the condition.
Symptoms
Pain
This is usual and common, in the upper abdomen just below the sternum (breastbone) at the so-called epigastrum, which is the upper central aspect of the tummy (abdomen). It occurs mostly before meals, or when there is hunger. Usually, it may be eased with food or with antacid medicines. The pain may wake the affected person from sleep, usually some four hours after the last meal. Such that it is not uncommon to hear a person suffering from peptic ulcer to complain of regularly woken up by pain in the tummy in the earlier hours of the morning viz;- around 1am and 2am.
Pain
This is usual and common, in the upper abdomen just below the sternum (breastbone) at the so-called epigastrum, which is the upper central aspect of the tummy (abdomen). It occurs mostly before meals, or when there is hunger. Usually, it may be eased with food or with antacid medicines. The pain may wake the affected person from sleep, usually some four hours after the last meal. Such that it is not uncommon to hear a person suffering from peptic ulcer to complain of regularly woken up by pain in the tummy in the earlier hours of the morning viz;- around 1am and 2am.
Other symptoms
Other symptoms which may occur include: bloating, retching, and feeling sick. The affected may feel particularly 'full' after a meal. Sometimes food makes the pain worse although this phenomenon is unusual for peptic ulcer but commoner in those with stomach ulcer.
Weight gainOther symptoms which may occur include: bloating, retching, and feeling sick. The affected may feel particularly 'full' after a meal. Sometimes food makes the pain worse although this phenomenon is unusual for peptic ulcer but commoner in those with stomach ulcer.
Weight gain is a related finding in those having duodenal ulcer, since as mentioned above, the victim soon discovered that the ulcer pain can easily be relieved by taking food or drinking soothing diary products like milk, yoghurt etc; so he/she keeps on taking in more and more. This inevitably adds up to weight gain in the individual with duodenal ulcer.
We shall conclude this discussion on peptic ulcer with evaluation of possible complications, preventive measures and treatment options in peptic ulcer in a later edition of this column.
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