A duodenal ulcer (duodenal ulcer) is a benign Ulcer (ulcer) into the duodenum (= duodenum), so deeply enough damage to the wall of the duodenum. Duodenal ulcers are at least four times as common as peptic ulcers.
Most common cause of a duodenal ulcer is an excessive secretion (Hypersecretion) of gastric juice. Other factors, such as certain drugs, nicotine or stress can encourage the formation of ulcers in the duodenum. Also seem infections with the bacterium Helicobacter pylori duodeni to play an essential role in the development of ulcer.
The duodenal ulcer is the most common form of permanent ulcer diseases. Its symptoms are less characteristic and ranging from pain, pressure and fullness in the upper abdomen, belching, bloating, nausea, or vomiting. First of all medications and changes in life design (e.g. stomach-friendly nutrition, avoidance of stress) used be a duodenal ulcer treatment. Only after multiple unsuccessful attempts of therapy or if complications occur, an operation requires duodeni in a leg.
Generally high cure rates can be at a duodenal ulcer by using an appropriate therapy achieved. Possible serious complications of Ulcus duodeni are bleeding and breakthroughs in the abdominal cavity that can develop a peritonitis (peritonitis).
Duodenal ulcer: Definition
A duodenal ulcer (peptic ulcer = ulcus duodeni, Latin duodenum duodenum) is a benign, inflammatory disease, where there is damage in the wall of the duodenum. In contrast to the so-called erosion, of which only the skin (epidermis) is damaged, the injury ranges into ulcer or ulcer by definition up in the deep layers of the wall.
The duodenal ulcer (duodenal ulcer) reveals a greater frequency than all other pathological changes of duodenum. At the same time, it is the most common persistent (chronic) ulcer disease. It occurs in Germany about four to five times as often as the stomach ulcer. It is estimated that 1.5% of the population of a duodenal ulcer are affected. Mostly, the disease between the 30th and 50th occurs at the age where 80 percent of sufferers are male.
In the duodenal ulcer (duodenal ulcer) the wall of the duodenum is damaged. As a section of the small intestine, the duodenum belongs to the anatomy of the digestive tract: the intestine is the tubular part of the digestive tract between the Magenausgang and anus. It consists of:
- the approximately 5 to 6 M long small bowel (intestines tenue).
- the 1.5 metre long colon (intestines crassum) and
- the 20 cm long rectum (intestines rectum).
The small intestine is divided into three successive parts: the duodenum (intestines duodenum), the Leerdarm (intestines jejunum) and the ileum (intestines ileum). The duodenum (duodenum) is a c-shaped curved tube of approximately 25 to 30 cm length – this is about the width of twelve side by side laid fingers. It is located in the upper abdomen, and ranges from the Magenausgang, the so-called Porter, until the beginning of Leerdarms. His wall consists of mucous membrane, muscle, connective tissue, and special glands that produce a mucus that neutralizes the stomach acid in the stomachs. In the Ulcus duodeni lead in addition the ducts of the pancreas and the gallbladder.
A major task of the small intestine is the inclusion (absorption) of digestible substances from food already crushed by the enzymes of the stomach and pancreas, the so-called stomachs. The surface of the small intestine has therefore on input elements (crypts and villi), which are covered by a thin brush fringe. It is estimated that this enlarged his Palm for the nutrients to up to 100 square meters.
So that the body can absorb different substances from the stomachs, certain enzymes must split the porridge (Digest). In the gut is the cleavage of proteins to amino acids, carbohydrates to simple sugars and fats to free fatty acids and Monoglyceriden. Especially the enzymes of the pancreas, whose Sekret is satisfied in the duodenum play a crucial role in this. The food is divided, the cells of the small intestine absorb the individual components. From there, the nutrients enter blood in the liver. To facilitate the exploitation and transportation of Speisebreis, make swaying movements (Peristaltic) in the small intestine, sure that the stomachs slowly forward and back and forth moving – so the indigestible food residues and finally reach the large intestine.
Duodenal ulcer: Causes
A duodenal ulcer (peptic duodenal) can have different causes. Basically, the high concentration of acid and enzymes in the gastric juice represents always a potential risk for the mucous membrane of the stomach and duodenum. An alkaline mucus that neutralizes the gastric acid, a high rate of blood flow and the production of so-called prostaglandins are among the complex mechanisms that normally prevent injury.
The mucosa can resist also destroyed by the gastric juice, by forms SECRETIN after food intake into the duodenum, which inhibits the secretion (secretion) of Magensafts. Any imbalance between the aggressive factors on the an and the protective on the other side inevitably leads to damage and can be as the cause of a duodenal ulcer.
Hypersecretion of gastric juice
See for a duodenal ulcer (duodenal ulcer) eligible causes an excessive secretion (Hypersecretion) of gastric juice plays the largest role. Gastric acid in excess – too much, too long, too often – destroys the mucous membrane. At night, the Hypersecretion is most pronounced and is particularly damaging because the acid is not sufficiently neutralized during the night fasting period. At the same time to the excessive secretion of the stomach empties often too quickly, which the mucosa of the duodenum increasingly comes with the gastric juice in contact.
For a duodenal ulcer (duodenal ulcer) also certain bacteria are as eligible: when 90 to 99 percent of all duodenal ulcers can be pylori prove the bacterium Helicobacter pylori. Another clue to the influence of the bacteria in the ulcer formation is the fact that when a germ proof in up to 80 percent of cases again ulcers (relapses) form. People with duodenal ulcer, but without the germ exists only in 10% of cases there.
Helicobacter pylori can survive in the acidic environment of the stomach and moved on to the surface of the gastric mucosa. There, the bacteria makes the enzyme urease and thus creating an alkaline environment that causes impaired regulation of gastric acid production and it also directly damages the mucous membrane. The colonization of the stomach with Helicobacter pylori increasing with increasing age. Nearly 60 percent of the over 60 in Western countries are infected with the bacteria. However, long since not all people where, Helicobacter pylori is detectable, develop pathological changes in the stomach or duodenum. The exact meaning of the bacteria for the formation of ulcers such as duodenal ulcer or ulcer duodenal is still unclear.
A duodenal ulcer (duodenal ulcer) certain diseases can be as causes based on: how the rare Zollinger-Ellison syndrome and the parathyroid glands Sebaceous (hyperparathyroidism) can cause that forms from a duodenal ulcer.
Both diseases are associated with an excessive secretion (Hypersecretion) of gastric juice: the so-called Zollinger-Ellison Syndrome caused by a tumor in the pancreas, which forms the hormone gastrin, which promotes the secretion of stomach acid. Combined with parathyroid glands causes an increased concentration of calcium in the blood, which in turn by gastrin and thus indirectly the gastric acid secretion promotes the distribution. And among the possible reasons for a duodenal ulcer, the excessive secretion of gastric juice has the greatest importance.
A duodenal ulcer (duodenal ulcer) much gastric juice or settlement by the bacterium Helicobacter pylori more factors can be in addition to the causes as overly responsible for: certain drugs such as non-steroidal anti-inflammatory drugs (NSAIDs, such as aspirin) and corticosteroids (e.g. cortisone), damage the mucosa and facilitate so the formation of gastric and duodenal ulcer (or Ulcus ventriculi and duodenal ulcer). Their impact is however strongly dependent on the amount of the dose and the duration of the use.
A duodenal ulcer could be also hereditary causes: duodenal ulcers frequent in families occur. If you have relatives with duodenal ulcer, is two to three times as often affected as others. In addition, people with the blood type 0 often get a duodenal ulcer. On these people, specific blood group antigens in gastric juice and saliva are missing. These observations can be on a hereditary tendency to educate the ulcers, close. The exact relationships are but remain largely unknown.
Other possible causes of a duodenal ulcer are nicotine and alcohol consumption: nicotine increases the nocturnal secretion of gastric juice and reinforced damaging an already existing imbalance between the mucous membrane and protective factors in this way. The damaging effect of alcohol on the mucous membrane of stomach and duodenum, however, is independent of the production of Magensafts. In high concentrations, alcohol acts one directly to the cells of the mucous membrane, causing damage which can be the starting point for the formation of ulcers.
Also psychological factors and special stress loads are duodeni eligible as possible causes for an ulcer. So the complaints to existing ulcers are increasing with increased stress. People with depression seem to develop duodenal ulcers in addition more frequently.
Duodenal ulcer: Symptoms
At a duodenal ulcer (peptic duodenal) occurring symptoms are not particularly characteristic: other disorders is reflected by similar signs, especially the stomach ulcer. The most common complaints in the duodenal ulcer are pain in the upper abdomen – usually at night and in a sober State (pain of fasting). Often, the pain Center located between the navel and the center of right Rippenbogens. In some cases the pain can be through food intake temporarily relieve.
Further signs of a duodenal ulcer are pressure and fullness in the upper abdomen, belching, bloating, nausea, vomiting and weight loss. Special situations of stress and the consumption of coffee and nicotine can increase the symptoms of a duodenal ulcer.
Duodenal ulcer: Diagnosis
A duodenal ulcer (duodenal ulcer) the signs, previous ulcer disease and a physical examination to diagnose not sufficient most: this information provide only preliminary evidence for a stomach bowel inflammatory disease. Generally on the basis of complaints but no distinction between gastric and duodenal ulcer is possible (or Ulcus ventriculi and duodenal ulcer). Nor can decide afterwards whether just an irritation or actually exists an ulcer. To diagnose a duodenal ulcer, so further research is needed.
Stomach duodenum mirroring
A duodenal ulcer is suspected (duodenal ulcer) stomach duodenum mirroring (Gastroduodenoskopie) is best suited for the diagnosis. In contrast to at stomach ulcers is this not necessary to obtain tissue samples from the duodenum (biopsy), because very rarely malignant tumors develop from duodenal ulcers. Therefore, a reflection occurs usually only to clarify atypical findings or to establish an infection with Helicobacter pylori.
A stomach duodenum mirroring for medical reasons is not possible, a duodenal ulcer is suspected (duodenal ulcer) the diagnosis by a X-ray can be with contrast media (so-called stomach-intestinal passage) secure.
Detection of Helicobacter pylori
At a duodenal ulcer (duodenal ulcer) is also a possible detection of Helicobacter pylori, one diagnosis for: 90 to 99 percent of all duodenal ulcers is verifiable this bacterium. There are special tests available to determine a Helicobacter pylori infection:
On the one hand, it is possible to examine the concentration of antibodies in the blood. Antibodies to the bacterium can be found here, the chance of an infection is underway at this time is quite high. However, the antibody concentration is also a long time after successful treatment of the infection maintained and thus is only meaningful when the diagnosis of duodenal ulcer.
Another way to detect Helicobacter pylori, is the so-called 13 C or 14 C-urea-breath test. Here, people take a test meal to containing the radiolabelled urea. An infection with Helicobacter pylori occurs the enzyme urease produced by the bacterium divides the urea and sets this 13 C or 14 C-labelled carbon dioxide free. Breathe out, it collects the moisturising off air in a container and determines the quantity of carbon dioxide contained therein. In this way the can for the duodenal ulcer (duodenal ulcer) might be responsible agents demonstrate a high probability. The radiolabelled urea radiation exposure is considered extremely low.
In addition the usually existing on a duodenal ulcer Helicobacter pylori infection by using a tissue sample obtained from the stomach duodenum mirroring is verifiable: bacteria are present, a bacterial culture can be from the sample breed. In addition a test can be done to diagnose urease in the biopsy sample.
In addition, the laboratory values can contribute may be underlying diseases to diagnosis of the duodenal ulcer.
Duodenal ulcer: Treatment
With a duodenal ulcer (peptic duodenal) is the first step of treatment is to relieve your complaints through General measures. This concerns inter alia the diet: a diet in which restrict the use of stomach-damaging foods such as coffee, alcohol, sharp spices and fatty substances, for example chocolate, is advisable with a duodenal ulcer. You should make smoking at least temporarily completely. In addition, you yourself must find out what foods trigger particular complaints. It is also advisable to relieve stress whenever possible or to develop appropriate response strategies for stressful situations with a duodenal ulcer. Mucous membrane-damaging drugs such as aspirin are, if possible, to depose.
The biggest success of healing with a duodenal ulcer (duodenal ulcer) can be with a therapy by drugs achieved, which inhibit the production of stomach acid, because: the most important to play in the development of duodenal ulcers the excessive secretion (Hypersecretion) of acid gastric juice. These drugs for the treatment of duodenal ulcer include in particular the Proton pump inhibitor (e.g. omeprazole) and the H2 blockers (e.g., ranitidine). Your discomfort subside within a few days by the reduced stomach acid production. After the symptoms have subsided, it is advisable to continue the treatment until about eight weeks, so that the damage to the mucous membrane can heal completely.
Also known as antacids (aluminium or magnesium hydroxide), which neutralize the stomach acid already secreted by the glands, are applicable when a Ulcus duodeni or duodenal ulcer therapy. It is however advisable to take antacids do not, in the longer term, because: after some time, the stomach in response to the treatment increases acid production. There are also alternative highly effective drugs against the duodenal ulcer at the disposal with the interactions and H2 receptor blockers.
An infection could be you with Helicobacter pylori prove a targeted use of antibiotics is recommended to treat your duodenal ulcer. Here come the clarithromycin, metronidazole and amoxicillin used, that at the same time to take are over a period of seven days in exactly defined dosage (so-called triple therapy).
Itself after about two or three attempts to treat the duodenal ulcer, no lasting successful treatment set (in about 5% of cases) or serious complications occur, surgery is necessary. Frequently, while the surgeon removed a part of the stomach (resection), to reduce the formation of gastric acid. Only in individual cases, the operative therapy of duodenal ulcers yet it is turn off the nerve supply of the acid-producing document cells in the stomach lining by a so-called Vagotomy (operative ablation of the nerves).
Duodenal ulcer: History
A duodenal ulcer treated with drugs (duodenal ulcer) is mostly a good flow: in over 90 percent of cases it can be successfully treated. However, the ulcer occurs after a certain time in many cases back (relapse). Preventive measures can reduce the risk for this however.
When a duodenal ulcer (duodenal ulcer) various complications may occur in the course: frequently, duodenal ulcers tend to the bleeding, which can assume different proportions. Smaller, permanently persistent bleeding often go unnoticed and lead eventually to an anaemia (anaemia). In addition, major bleeding from the duodenal ulcer in the form of so-called crater tar chairs (Melaena) may occur up out to large acute mass bleeding that can lead to a blood volume deficiency shock.
Further complications are possible if collapses (penetration) and glazed bridges, so-called fistulas, makes a duodenal ulcer in neighboring organs such as the pancreas, colon, and liver. This leads to severe pain which preferentially radiate in the back. A participation of the pancreas is often an accompanying pancreatic inflammation (pancreatitis).
A life-threatening complication that can occur when a deep duodenal ulcer is its breakthrough by all the wall layers of the bowel (perforation). While the contents of the intestine and air come over from the stomach in the abdominal cavity. Later, a severe peritonitis (peritonitis) educates then.
The duodenal ulcer or ulcer is duodeni close to the stomach, held scarring processes in the course of the inflammatory disease can lead to a narrowed Magenausgang. This hindered the passage of food, which is why people can accommodate only small portions of food and often vomit and weight lose. In advanced forms a so-called hourglass stomach, characterized by an extremely large body and a heavily constrained output.
Duodenal ulcer: Prevention
You can prevent (duodenal ulcer) best a duodenal ulcer, by you take general measures to create a satisfactory living conditions. This includes in particular cope with daily stress. Certain strategies such as autogenic training or progressive muscle relaxation can help this. Also frequent physical activity – such as by walking, cycling, jogging or swimming – helps to reduce harmful stress hormones, and ensures larger balance.
To avoid a duodenal ulcer, also a balanced diet is recommended. It is important that you avoid all food and beverages that cause discomfort, largely. Restrict the enjoyment of nicotine, alcohol, sharp spices and fat for the benefit of other foodstuffs, which weigh less heavily on the stomach.
If you have struggled with recurring ulcers in the duodenum, an additional prevention by drugs is possible. Proton pump inhibitors or H2 blockers are used here at a lower dose than in treating an existing duodenal ulcer. Even if you have a high risk because of another disease, an ulcer duodenal or educate duodenal ulcer, is recommended for such a drug prevention. This applies for example, if you have a rheumatic joint disease, which you are taking permanent non-steroidal anti-inflammatory drugs.