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Duodenal ulcer (DU), Causes, Symptoms and Treatment

Duodenal ulcer (DU), Causes, Symptoms and Treatment

Duodenal ulcer

Ulcer develop in the duodenal bulb or between the bulb and the ampule.

duodenal-ulcer
duodenal-ulcer
Causes
  • Excess acid secretion may destruction of mucosal barrier.
  • Infected by Helicobacter pylori.
  • Genetic factors
  • Drug-induced gastritis (eg. antibiotics,  NSAIDs ,Corticosteroid,  bisphosphonate,Calcium channel blockers, antidepressants,  iron,  nitrates,   theophyline etc.
Sign and symptoms
  • Pain in epigastric area
  • Pain radiate below the costal margins into the back for the right solder
  • Food  may relief pain
  • Weight  gain
  • Heartburn, cramp like pain abdominal soreness
  • Hunger sensation
  • Nausea, vomiting
  • Some time black stool, occult blood in stool
  • Anemia.
Diagnosis
  • Serum pepsinogen 1 should measure
  • Dodenal ulcer patient   pepsinogen1 and gastrin hormone elevated in serum.

It is very important to detect helicobacter pylori infection,  about 60%  peptic ulcer disease caused by helicobacter pylori.

Detection
  • Use carbon 13 urea breath test, stool antigen test laboratory base anti helicobacter pylori IgG antibodies .
  • Stool test( black stool for occult blood in stool),
  • Blood test( anaemia)
  • Androscopy.

Treatment  of Duodenal ulcer (DU)

Treatment by medicine is similar like PUD. It is very important to eradicate the Helicobacter pylori at first.

 

Use antibiotics combination

Clarithromycin 500 mg once daily for 7 to 10 days with amoxicillin 500 mg three times daily.

With co-admistration  acid  suppression drugs… like H2 receptor blocker drugs (eg.  famotidine or Nizatidine.) or PPI ( eg.  esomeprazole pantoprazole or  lansoprazole) and antacid preparetion.

Sucralfate
  • 1g 4 times per day 4- 8 weeks
  • Drugs  should use at least 2 hours before meal.

If if NSAID  cannot omite  with treatment  regiment,   it should better to choose alter the admistrasion route .

Dose adjustment

Nizatidine

150 mg  two times daily  for 4 weeks 30 minutes before the meal,  then once daily at night for two weeks,  if symptoms not relief extend the the treatment time for  two weeks.

Famotidine

20 mg  two times daily  for 4 weeks 30 minutes before the meal,  then once daily at night for two weeks,  if symptoms not relief extend the the treatment time for  two weeks.

PPI ( Proton Pump Inhibitor)

Esomeprazole 20 mg or prantoprazole 40 mg may be given 2  times a day  30 minutes before of meal for 3 weeks. Last 1 weeks once a day at night before the 30 minutes of meal. Dexlansoprazole is better to use 30 mg 1 or 2 times a day for 4 weeks. First 20 days  2 times a day 30 minutes before the meal and then 10 days a single dose for withdrawing the drug at night before the 30 minutes of meal.

With added a antacid preparation (eg. aluminum hydroxide and magnesium hydroxide) 1-1.5 hours after meal .

Advice

 It is very important for all gastritis,Peptic ulcer disease, duodenal ulcer disease , gastroesophageal reflux disease, gastric ulcer disease patients .

Diet

  • Patient should concern about his meal.
  • Should be less spicy less oily .
  • Less consume free sugar or sugar containing in food
  • Try to avoid heavy fiber food
  • Avoid  coffee
  • Alcohol
  • Avoid milk
  • Cigarette are  prohibited strongly.

Lifestyle

Patient  should obey the following guideline for better feel and withdrawal the medication .

Daily activities
  • Wake up at morning 6 a.m take a glass of fresh water
  • Then take100- 150 gram green papaya
  • Then take breakfast at 8 a.m.
  • At 11 a.m. take a sugar free toast biscuit with a glass of fresh water, then chewing a chewing gum for 40 to 50 minutes.
  • Take your lunch within 2 p.m.
  • At 5 p.m. take a sugar free toast biscuit with a glass of fresh water.
  • Then chewing a chewing gum for 40 to 50 minutes.
  • Take your dinner within 8 to 9 p.m.
  • Go to bed within 10:00 to 10:30 p.m.