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A resident asks: Doctor, I am suffering from duodenal ulcer for the last four months. After the diagnosis, I am taking medications, including rebraprazole, domperidone and antacid daily. But I am not feeling any improvement. Could you please guide me as to how to manage the condition?

Dr. Jayakumar B Kannan, Specialist Gastroenterologist at Aster Medical Centre in Deira, replies: Thank you for sharing your problem with us. However, your question seems incomplete because it lacks information of your age and detailed history, or whether you have a habit of smoking/consuming alcohol or are you taking pain killer pills for any disease. You have been diagnosed of duodenal ulcer. This diagnosis may be made by either endoscopy or blood or stool test for h-pylori.

First of all, let me explain what an ulcer is. An ulcer is an open sore or lesion, usually found on the skin or mucous membrane areas of the body. When there is an ulcer which occurs in the lining of the stomach or duodenum, where there are acids such as hydrochloric acid and pepsin present, it is called a peptic ulcer, and when a peptic ulcer is located in the duodenum area of the stomach, it is called a duodenal ulcer.

There are many etiologies for duodenal ulcers. The most common one is the ulcer being a result of infection with a bacterium called Helicobacter Pylori (H. pylori). It is known to produce substances that weakens the stomachs protective mucous and makes it more susceptible to the damaging effects of acid and pepsin as well as it leads to producing more acid.

The stomach acids Hydrochloric Acid and Pepsin are known to be the cause of ulcers. Lifestyle disorders and factors such as diet and stress is believed to cause ulcers as emotional stress increases the pain of stress, caffeine can cause acid secretion hence should be consumed in limited amounts, smoking increases the chances of ulcers and also prevents and slows down the healing of an existing ulcer too. Consumption of non-steroidal anti-inflammatory drugs increases the vulnerability of the stomach. A family history of developing duodenal ulcers may also be a possibility or ischemia and very rarely it can be due to malignancy.

  • Some of the symptoms of duodenal ulcer are a burning pain in the abdomen, and belching, nausea, vomiting, poor appetite, loss of weight, feeling of tiredness and weakness. Complications such as bleeding (damage of blood vessels), perforation (hole through the wall of stomach or duodenum), and narrowing and obstruction can occur if the ulcers cause swelling and scarring which can narrow or close the intestinal opening.

Your treatment can be based on your age, health, medical history and tolerance. You have been on above mentioned medication for the last 12 weeks or more. You are not responding to the treatments. Definitely you need an UGI Endoscopy to confirm the diagnosis. Through endoscopy we can see if your ulcer type is single or multiple, and is it bleeding or not bleeding; also we can confirm the presence of H-pylori bacteria by a rapid increase test (CLO test).

We can also proceed for biopsy and send to pathology for other cause of peptic and duodenal ulcer. Based on that we can proceed further to know what treatment you require, whether it can be treated with medication or a surgery is required.

  • However, do try to avoid spicy food, acidic foods and foods that can cause irritation in your stomach. Avoid habits such as smoking and drinking if you are into it and do not take any painkillers till they are not prescribed by your doctor.

I would advise you to show to the doctor before the ulcer gets more severe.

DisclaimerThis blog is a conversation and is not an alternative for treatment. The recommendations and suggestions offered by our panel of doctors are their own and Gulf News will not take any responsibility for the advice they provide.