Can a duodenal ulcer become malignant? | Duodenal ulcer

Can a duodenal ulcer become malignant?

A malignant (malignant) degeneration rarely occurs in duodenal ulcers. Malignant degeneration occurs in about 1-2% of patients with peptic ulcer, and in duodenal ulcer degeneration is much rarer. In chronic cases, degeneration is generally more probable, which is why an endoscopic examination should be performed at least every two to three years.

If a duodenal ulcer is medically treated, degeneration is much less likely. Ulcers of the duodenum rarely develop into cancer. More often this can be the case with stomach ulcers. In order to be able to make a reliable distinction between ulcer and cancer, a sample must be taken from the affected area during a gastroscopy. The sample must then be examined in a pathological institute for fine tissue analysis, where a diagnosis can then be made.

Symptoms

The main symptom is the so-called sobriety pain in the upper abdomen, i.e. a pain that persists when one has not eaten anything. It often improves when you start eating or when you take an antacid (a drug that neutralizes stomach acid). Especially in the morning the pain is usually severe.

Other symptoms may include nausea and vomiting. If there is already chronic bleeding from the duodenal ulcer, the symptoms of anemia can become apparent: Tiredness and reduced resilience, shortness of breath especially under stress, paleness (especially of the mucous membranes) and possibly palpitations. In rare cases, vomiting of blood or tarry stools may occur (the stool is then usually not red but black, which is caused by the coagulated blood converted in the intestine).

Symptoms such as abdominal pain and bloating can be aggravated in some patients by the consumption of alcohol or nicotine. However, a duodenal ulcer can also be completely without symptoms. The first signs of a duodenal ulcer are pain in the upper abdomen, especially in the morning or after a certain time without food intake, which improves after eating.

If the symptoms persist over a long period of time, there may be a certain periodicity in which the pain is better at some times than at others. Studies have shown that the pain occurs mainly in spring and autumn. Signs of acute bleeding often occur without prior abdominal discomfort, but instead a shock “out of the blue” occurs (volume deficiency shock, i.e. a total lack of blood in the vascular system due to the blood loss caused by bleeding) with accelerated breathing, palpitations, a drop in blood pressure, paleness, cold sweat, confusion and unconsciousness.

Back pain may occur when the upper abdominal pain radiates. Radiation of this type occurs more frequently in stomach ulcers, but it is not possible to distinguish between the two localizations on the basis of this symptom. Sometimes the pain can radiate into the shoulder, or into the chest, but all these are very unspecific signs, as they are also present in many other diseases.

Furthermore, the pain radiates differently from person to person. Approximately every tenth patient with a duodenal ulcer has a bleeding once during the course of the disease. Depending on the size of the bleeding, this acute symptomatology can lead to circulatory shock and become dangerous, or it can become chronic over a long period of time.

Typical signs of bleeding are vomiting of blood (hematomesis) and tarry stools (melena). This is a black coloration of the stool caused by blood converted in the intestine.In chronic bleeding, the constant loss of blood causes the symptoms of anemia: Tiredness and reduced resilience, shortness of breath, especially under stress, paleness (especially of the mucous membranes) and possibly palpitations. The diagnosis is made by endoscopy of the esophagus, stomach and twelve-ingered intestine (esophagogastroduodenoscopy).

Here it must be determined how strong the bleeding is. As a rule, it is also treated immediately by endoscopy. The source of bleeding can be treated in different ways: In the rarest case, the bleeding cannot be controlled and surgery is required.

  • By injection (highly diluted adrenaline is injected into the bleeding intestinal mucosa, causing the blood vessels to contract and the bleeding to stop),
  • By fibrin glue (a spray consisting of fibrin components is applied to the bleeding, which causes a natural formation of blood clots and thus stops the bleeding),
  • By mechanical “clipping” (usually metal clips are pressed onto the bleeding vessel like a staple gun, thereby mechanically stopping the bleeding) or
  • By coagulation (here the bleeding vessel is burned with the help of a targeted electrical impulse, which closes the wound quite reliably)

Diarrhea is not really a typical symptom of a duodenal ulcer. If both occur together, the diarrhea usually has a different cause than the ulcer. Flatulence is a symptom that is more common in duodenal ulcers. However, it is unspecific because flatulence can occur in many situations. Much more typical is the sobriety pain in the area of the upper abdomen which can appear at night.