Clicinical features: The most typical symptom of duodenal ulcer is pain. The pain occurs when the stomach is emptying its contents through duodenum, so the pain starts about 2 hours after taking food and is relieved by taking food. The patients with duodenal ulcers tend to be overweight due to frequent consumption of food to relieve the pain. The pain is in the epigastric region or right hypochondrium. It may radiate to the back. Most diagnostic feature of pain of duodenal ulcer is that it occurs in the early morning hours while the acid production is high and the stomach is empty. The symptoms of duodenal ulcer have periodicity, that is , the symptoms are present for a few weeks and this is followed by of a few months of symptom free period. Pain is more in winter and autumn and remissions are more in summer. Other symptoms of duodenal ulcer are water brash, heartburn, dyspepsia and bleeding with associated hematemesis or melina.
Diagnosis: Barium meal radiographs show duodenal ulcer very well. Upper gastro-intestinal endoscopy is very useful in diagnosing duodenal ulcer and for taking a biopsy for evidence of Helicobacter pylori infection.
Management: Initial treatment of duodenal ulcer is always medical. H2 receptor antagonists and proton pump inhibiting drugs are very useful in the treatment of duodenal ulcers, the patients becoming asymptomatic very fast. In addition to these drugs antacids, anticholinergic drugs may be needed for faster symptomatic relief. If Helicobacter pylori infection is established, addition of antibiotics, metronidazole and bismuth salts are used. Eradication of H.pylori infection ensures longer remission period.Surgery: Surgery is indicated for any of the complications of duodenal ulcer or for ulcers which do not heal with medical treatments or for those people who develop frequent recurrences. A large variety of surgical procedures are available for duodenal ulcer. The most popular procedures are truncal vagotomy combined with a draining procedure like pyloroplasty or gastro-jejunostomy. Some surgeons prefer a partial gastrectomy with gastro-jejunostomy.
Complications of duodenal ulcer: Long standing duodenal ulcers which do not respond well to drug therapy tend to develop complications. Duodenal perforation , Duodenal stenosis with associated intractable vomiting, bleeding from the ulcer with associated hematemesis and melina.