Ulcers can occur anywhere on and in the body. The stomach and small intestine are especially commonly affected by an ulcer. An intestinal ulcer is most often located in the duodenum, the small intestine. In medical terminology, a duodenal ulcer is called a duodenal ulcer.
What is a duodenal ulcer?
An ulcer is a deep-seated defect in the skin or a mucous membrane. It usually develops on pre-damaged tissue structures and has a very poor tendency to heal itself. In duodenal ulcer, persistent inflammation destroys the mucosal tissue. At the beginning of the disease, the lesions affect only the uppermost layers of the intestinal mucosa. If the inflammatory change remains untreated, the destruction of the tissue can spread to the muscular layer of the duodenum.
Causes
Intestinal ulcers occur in clusters in some families. Therefore, there appear to be genetic predispositions that favor the development of intestinal ulceration. In most cases, the triggers are the digestive enzyme pepsin and gastric acid produced in the stomach. These act on the mucosa, which is pre-damaged in the stomach or in the duodenum directly behind it, and cause inflammation. The mucosa lining the stomach and intestines normally protects the organ walls from the aggressive stomach acid. However, the protective function of the mucous membrane can be damaged by psychological stress, stress in the family and at work, by alcohol consumption and by smoking. The mucous membrane of the stomach and intestines is also stressed by the use of certain medications such as non-steroidal anti-inflammatory drugs (e.g. diclofenac, ibuprofen). Simply taking common painkillers containing the active ingredient acetylsalicylic acid (e.g. aspirin) already has a negative impact on the protective function of the intestinal mucosa. In recent years, it has been observed that infection with the pathogen Helicobacter pylori also plays a major role in the development of intestinal ulcers. Inflammatory lesions also occur when the tissues of the intestine are undersupplied because of circulatory problems.
Symptoms, complaints, and signs
An intestinal ulcer may manifest itself by a variety of symptoms, most of which are nonspecific. Injuries to the intestinal mucosa are manifested, for example, by pain in the affected region or a feeling of fullness. In addition, typical gastrointestinal complaints such as nausea, vomiting and loss of appetite may develop. In individual cases, duodenal ulcer leads to severe, probing pain in the abdomen, which typically occurs on an empty stomach or at night. The symptoms usually diminish with a meal. The situation is different with gastric ulcer, in which pain and an unusual feeling of pressure in the abdomen occur after eating. An ulcer at the stomach outlet manifests itself by regular vomiting and a loss of weight. It may also cause constipation, diarrhea and other typical symptoms and discomfort. Any intestinal ulcer can cause bleeding, which can be recognized by a red or black coloration of the stool. Often, the blood is also vomited. Regular, unnoticed blood loss can cause circulatory shock. This is preceded by fatigue and exhaustion. In a severe course with recurrent bleeding, the patient’s appearance also changes: The skin becomes pale, the eye sockets darken, and hair loss may occur. These symptoms are accompanied by an increasing feeling of illness.
Diagnosis
The complaints expressed by the patient with an intestinal ulcer often focus on burning and probing pain in the upper abdomen. If the pain improves after eating, this is a typical symptom of duodenal ulcer. In addition to irregular bowel movements, a constant feeling of fullness, nausea and vomiting, weight loss may also occur in the advanced stage of the disease. If the intestinal ulcer remains untreated, bleeding and perforation may occur in the affected area of the intestine. The diagnosis of duodenal ulcer is confirmed by endoscopy. It is important to take and examine a tissue sample endoscopically to rule out carcinoma. The presence of Helicobacter pylori can be detected by a breath test, the Helicobacter urease test or directly on tissue samples taken. Meanwhile, there is also antigen detection in a stool sample and the detection of antibodies in blood serum.
Complications
Intestinal ulceration can cause a number of complications. First, there is a risk of hemorrhage, which can lead to anemia and associated severe deficiency symptoms. If blood loss is high, circulatory shock may occur. In the long term, bleeding in the gastrointestinal tract can cause chronic anemia, which is associated with fatigue and a decrease in mental performance. Rarely, gastric perforation occurs, associated with violent inflammation of the peritoneum and severe pain. In addition, an intestinal ulcer can perforate an adjacent organ and cause severe inflammation and stress reactions. If a blood vessel is damaged, life-threatening ulcer bleeding may occur. Intestinal ulcers at the outlet of the stomach can cause narrowing as they heal. As a result, food can no longer be passed unhindered and the patient has to vomit. As a result, weight loss occurs and this can sometimes lead to further complications. During the surgical removal of an intestinal ulcer, the intestinal walls as well as nerve cords and vessels can be injured. Prescribed medications sometimes cause severe reactions such as nausea and vomiting. In addition, allergies and intolerances can occur and slow the recovery process.
When should you see a doctor?
Growths in the abdomen or changes in the skin in the intestinal region should always be clarified by a doctor. If additional pain occurs that lasts for several days or increases in intensity, medical examinations must be initiated. In case of repeated diarrhea symptoms that are not due to unhealthy food intake, it is recommended to consult a doctor. Changes in bowel movements, discoloration, bleeding around the anus, or flatulence that cannot be explained should be investigated and treated. The causes of persistent heartburn, a feeling of fullness or a feeling of pressure in the abdomen, should also be clarified by a doctor. If there is unplanned weight loss or an unusual loss of appetite that is present for several weeks, there is cause for concern from a medical perspective. A general malaise, elevated body temperature, dizziness, and nausea and vomiting should be evaluated by a physician if they occur over several days. Since early diagnosis of an intestinal ulcer determines the further course of the disease and recovery, it is advisable to consult a doctor as early as possible when symptoms occur. A diffuse and clearly explicable feeling in the body is already sufficient to consult a doctor. If, for seemingly no reason, the usual performance drops or emotional problems set in that cannot be explained, a doctor should be consulted.
Treatment and therapy
Treatment of an intestinal ulcer may take place over a long period of time. For long-term success, the patient’s cooperation is necessary to eliminate triggers of intestinal ulcer that may be suspected in lifestyle or diet. The patient should distribute food intake over frequent smaller meals throughout the day. Hot spices should be avoided, as well as alcohol, nicotine and coffee until the intestinal ulcer heals. Drug treatment is carried out with proton pump inhibitors (PPI). They inhibit the formation of gastric acid. In the case of a proven infection with Helicobacter pylori, an antibiotic is also prescribed. If the disease has a psychosomatic background, targeted psychotherapy can have a positive effect on the healing process. Surgery for gastric or intestinal ulcers is rarely performed today. Only in the case of recurrences or occurring complications, a surgical intervention may become necessary.
Outlook and prognosis
An intestinal ulcer may resolve after eight to twelve weeks without treatment. With a balanced diet and a healthy lifestyle, healing is possible without the administration of medication. The self-healing powers of the organism can fight the causes of the intestinal ulcer and thus enable healing. The prognosis improves when medical care is sought. With antibiotics and acid inhibitors, the patient has the prospect of being symptom-free after only five to ten weeks. The main trigger of an intestinal ulcer is a Helicobacter pylori infection. When treated with antibiotics, this leads to a cure in far more than half of cases.If the treatment does not work or is not sufficient, it is then repeated up to three times. The success rate with this procedure is very high and is around 95%. In very rare cases, the bacterium is still detectable after a third repetition. Without medical care, patients have a high risk of recurrence. In approximately 40-80% of cases, untreated individuals will have a recurrence of intestinal ulceration. The risk of a chronic course is also present. If there is a psychological cause, the otherwise very good prognosis deteriorates. Persistent stress or strain can complicate or prevent healing.
Prevention
Recurrence of intestinal ulcer can be prevented by taking medications as directed by a physician, eating a healthy diet, and living a lifestyle free of excessive negative stress. Smokers should refrain from nicotine use altogether. In addition, the recommendation is to incorporate sufficient exercise into daily life. It helps to quickly reduce harmful stress hormones. It is important that the patient relearns to have the ability to consciously allow himself times of rest and relaxation, even in stressful times.
Aftercare
After therapy has been completed, regular follow-up examinations serve to rule out recurrence. Affected patients whose place of residence is not close to the hospital can discuss a referral to a gastroenterologist in private practice and other specialists with the attending physicians. These specialists are familiarized with the individual diagnosis and therapy via a discharge letter and can subsequently perform all control examinations. The frequency and type of examinations are determined individually based on the present stage of the disease. Patients in whom the circumferential proliferation was detected at an early stage usually do not require intensive follow-up. For them, a simple colonoscopy is sufficient, which is initially performed after six months and later at five-year intervals. It serves mainly as a precaution against new disease. All other patients must undergo a colonoscopy every six months during the first two years after the start of therapy, as the probability of a recurrence is greatly increased during this period. Thereafter, annual controls with colonoscopy are sufficient. According to current scientific knowledge, the risk of recurrence after five years is extremely low. Nevertheless, it is recommended to have a colonoscopy every five years as a preventive measure. If symptoms occur between follow-up examinations, however, the patient should not wait until the next appointment, but should see his or her treating physician immediately.
What you can do yourself
In the case of an intestinal ulcer, prevention is the best treatment. After the ulcer has been diagnosed, the cause should be determined and corrected as soon as possible. Most often, gastrointestinal ulcers are caused by an unhealthy diet or stress. Both can be remedied by a change in lifestyle. Dietary measures can be worked out together with the doctor or a sports physician and are useful in the case of an intestinal ulcer already during the illness. Other measures, such as a change of environment or exercise, should be implemented in consultation with the appropriate medical professional. In the case of chronic pain, other strategies are recommended: regular showers, breathing exercises or acceptance. In the long term, most intestinal ulcers can be treated, but sometimes chronic gastrointestinal symptoms remain. These can sometimes also be counteracted by a healthy and balanced diet and other measures. However, affected persons should also inform themselves about the disease and talk to other affected persons. The doctor in charge can provide further information on self-help groups and also refer the affected person to a therapist if necessary. Regular discussions with friends and family members are also useful for coming to terms with and accepting a serious illness.
