Definition
The duodenal ulcer (Ulcus duodeni) is an inflammatory wound of the intestinal mucosa in the area of the duodenum. The duodenum is the first section of the small intestine following the stomach. The ulcer, i.e. the wound, extends beyond the muscle layer of the mucous membrane of the small intestine (lamina muscularis mucosae).
Dangerous complications arise as soon as the ulcer attacks blood vessels, especially arteries, in the wall, as this can lead to heavy bleeding. In rare cases, it can even lead to a perforation of the intestinal wall. The duodenal ulcer belongs to the group of gastroduodenal ulcer diseases and is therefore closely related to the gastric ulcer, since the same disease mechanism is present. The duodenal ulcer occurs about five times as frequently as the stomach ulcer. In most cases, the ulcer lies on the front or back wall of the first part of the duodenum, i.e. directly behind the stomach exit.
Treatment
The aim of the therapy is to accelerate the healing of the duodenal ulcer while minimizing complications and pain. The therapy consists of general, medicinal and surgical aspects. The general therapy lays a supportive foundation for the drug therapy and helps to prevent recurrences over a long period of time.
The most important point here is to avoid nicotine in. Also with an adjustment of the diet an acceleration of the healing process as well as a reduction of pain can be achieved (see diet). Painkillers such as ASA (e.g. Aspirin®) or ibuprofen should – if possible – be discontinued or replaced by another, less stomach-damaging painkiller.
The aim of drug therapy is to neutralize the aggressive stomach acid or to reduce its formation. PPIs (proton pump inhibitors, e.g. pantoprazole, omeprazole), which directly reduce the formation of stomach acid, play the greatest role in this respect. Other drugs such as antacids (neutralization of the acid) or histamine 2 receptor antagonists (reduced acid formation) hardly play a role nowadays.
If a Helicobacter pylori infection has been detected, antibiotic therapy (“Italian” or “French” triple therapy) is administered according to certain standard procedures to treat the Helicobacter pylori infection. In most cases, the duodenal ulcer heals without any problems. If no Helicobacter pylori infection is detected, a four-week therapy with proton pump inhibitors is usually initiated.
If recurrences occur, i.e. if ulcers reappear, this therapy can be continued according to the doctor’s instructions. It is important in drug therapy that the drugs are taken until the end, even when the symptoms have subsided, so that the duodenal ulcer can heal completely. Only in rare cases is intermittent therapy recommended, i.e. taking medication when symptoms are present and stopping when symptoms subside.
With this form of therapy, regular endoscopic monitoring of the ulcer is important, as there is an increased risk of cancer. As a rule, surgical therapy is only necessary in the event of a perforation or massive bleeding. Prophylactically, low-dose therapy with proton pump inhibitors can be carried out over a long period of time.
If drugs such as ASA or ibuprofen have to be taken regularly, a prophylactic therapy with proton pump inhibitors should be carried out. For the treatment of a duodenal ulcer, as mentioned above, proton pump inhibitors are usually the most commonly used. These are drugs that significantly inhibit acid production in the stomach.
Since gastric acid is the main damaging trigger in the development of an ulcer, there is usually a significant reduction in symptoms after a few days of use. Proton pump inhibitors include pantoprazole and omeprazole. If there is an infection with Helicobacter pylori, it must be eliminated.
There is the so-called eradication therapy which consists of two antibiotics and a proton pump inhibitor. This combination of three must then be taken over seven days. Also medicines from the group of antacids can be used therapeutically.
They neutralize the stomach acid. These include sucralfate and aluminum hydroxide, for example.However, antacids have now been largely replaced by proton pump inhibitors. In the presence of a duodenal ulcer, care should be taken to ensure a healthy and balanced diet.
Sufficient dietary fibre, which is mainly found in fruit, vegetables and wholemeal products, no fatty or spicy foods. Several small meals a day are recommended. You should also make sure that you drink a sufficient amount of water, and avoid carbonated drinks and coffee during the acute stage of the ulcer.
In general, no specific diet is necessary in the case of a duodenal ulcer, but complaints can improve significantly with frequent, small meals that are regularly distributed throughout the day. In addition, care should be taken to avoid so-called “acid looseners”, which result in increased production of stomach acid. The classic “acid looseners” include alcohol, coffee and other caffeinated drinks (cola!
), as well as citrus juices. If a duodenal ulcer is present, it should not be treated with home remedies but with effective medication. Therefore, it should be presented to the family doctor, who will then decide on the further therapy.
An untreated ulcer can lead to serious complications and should therefore always be treated. Home remedies alone are not a solution in this case. Household remedies can be used as a supplement in consultation with the treating physician.
Household remedies are considered to be foods that are easy on the stomach, such as semolina porridge and gruel. Regular consumption of wormwood tea can also bring about an improvement, not least because wormwood has an anti-inflammatory and digestive effect. Camomile tea and lemon balm tea are also used as home remedies for duodenal ulcers. Just like household remedies, homeopathic remedies should not be used alone for duodenal ulcers, as they do not usually lead to a cure. A lack of treatment can lead to the development of sometimes life-threatening complications such as bleeding.
