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  Duodenal ulcers

The Duodenum is the part of the small intestines that is between the stomach and the rest of the small intestines. An ulcer is an open lesion or sore that is difficult to heal. A Duodenum ulcer is an open lesion or sore that is located in the duodenum intestine or the connection between the stomach and the small intestine.

Duodenal ulcers Digestive system
Duodenal ulcers


What are the Symptoms of Duodenal Ulcers?
The most noted symptom is pain just below the sternum or upper abdomen. The pain mostly happens just before meals or when hunger occurs. The pain may be relieved by antacids or when food is eaten. The pain may be more severe during sleep and the severity may wake up the sufferer. Other symptoms are vomiting; an unusually full feeling after eating and sometimes food makes the pain worse.

What Causes Duodenal Ulcers?
A common belief is that duodenal ulcers are caused by too much stomach acid. Most people who have ulcers have a normal amount of acid in their stomachs. The lining of the duodenum makes a chemical and mucus to cover and protect it from acid. The ulcer is the result of the acid breaking through a weak spot in the duodenums protective mucus and chemicals.

The acid breaks through the protective mucus for three reasons:
• Anti-inflammatory medicines which many people take for arthritis, muscular pains, etc. For example: aspirin, ibuprofen, and diclofenac - but there are others. These medicines sometimes affect the lining of the duodenum and allow acid to cause an ulcer.
• Infection by H. pylori is the cause in about 19 in 20 cases. This bacterium affects the lining of the duodenum in some way which allows the acid to cause inflammation and ulcers.
• A rare cause is Zollinger-Ellison syndrome, in which the stomach acid content is too high for the duodenum to protect itself. Heavy smoking, stress and heavy drinking may also increase the risk of duodenal ulcers. They are not, however the cause.

Complications:
In a small number of patients some serious complications can occur. Ulcers can begin to bleed beginning with a small amount and then possibly to a dangerous amount of blood loss. The ulcer may perforate or tear. This is very serious because the food and acid of the duodenum leak into the abdominal cavity. A perforation causes severe pain. A heavy bleed and a perforation are medical emergencies. What procedures diagnose a Duodenum Ulcer

What tests may be done?
There are two options for diagnosis to confirm an ulcer. The first is an endoscope which allows a doctor to view the inside of the stomach and duodenum. A small flexible telescope is passed down the esophagus so that any inflammation or ulcer can be viewed. The second test is performed if a duodenal ulcer is found. Either by a fecal sample, breath test or biopsy during an endoscope exam will determine if the bacterium H. Pylori is present. An Upper GI is a serious of x-rays of the patient. A barium solution is ingested to better view the stomach and small intestines.

How are Duodenal Ulcers Treated?
Almost all Duodenal Ulcers are caused by an infection or overgrowth of the H. pylori bacterium. This condition is treated by two antibiotics and an acid reducer. This is a combination therapy known as triple therapy and lasts for a week to ten days. Nine out of ten cases are cured and no further treatment is necessary. In some cases the infection can return.

Further testing can be performed if the symptoms do not disappear. If a perforation has occurred, then it is advised to be followed by a physician to be absolutely sure that the ulcer and perforation have healed.

In the case of where an ulcer does not heal, surgery may be required. Three types of laparoscopic surgery can be performed to treat the duodenal ulcer. The first is a vagotomy – which cuts part of the nerve that indicates to the brain to produce more stomach acid. Second is the antrectomy which removes the lower part of the stomach. This part of the stomach produces a hormone which induces the stomach to secrete digestive juices. A pyloroplasty Is the third option. The opening of the duodenum into the small intestine is enlarged enabling the contents of the stomach to pass more easily to the small intestine. The antrectomy and pyloroplasty procedures are often paired with the vagotomy surgery.

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