American Medical Association Family Medical Guide - American Medical Association [490]
Duodenal ulcer
A duodenal ulcer is a sore in the wall of the first part of the small intestine (the duodenum) caused by erosion of the lining of the duodenum.
Diagnosis
If you have symptoms of a peptic ulcer, your doctor will perform a procedure called endoscopy (see page 766) to examine your esophagus and stomach and possibly to take a sample of tissue for examination under a microscope (biopsy). Your doctor may order tests to look for blood in the stool, or blood tests to check for H. pylori or an iron deficiency (anemia; see page 610). Anemia can be a sign of internal bleeding.
Treatment
Reducing the amount of acid in the stomach is the usual treatment for peptic ulcers. Your doctor may recommend an over-the-counter antacid or may prescribe one. He or she may also prescribe a medication that coats the ulcer to protect it from stomach acid and allow it to heal. If your doctor detects H. pylori in the biopsy, he or she will prescribe antibiotics. Don’t take over-the-counter antacids unless your doctor has diagnosed a peptic ulcer and has recommended them. Taking antacids can mask symptoms of more serious disorders such as stomach cancer. Stop smoking, because smoking can irritate the stomach lining and slow healing.
In rare cases, surgery is necessary to treat a peptic ulcer. A surgeon may close a severely bleeding perforated duodenal ulcer with stitches. In a procedure called vagotomy, the surgeon may cut the nerves responsible for controlling the production of stomach acid. Usually the stomach outlet is widened (in a procedure called pyloroplasty) at the same time to prevent tightening of the pyloric muscles that would normally follow vagotomy. For duodenal ulcers, a surgical procedure called gastrojejunostomy (see next page) is sometimes performed to create an opening from the stomach to the middle section of the small intestine (jejunum) and close the opening into the duodenum.
Helicobacter pylori in stomach lining
Helicobacter pylori is a spiral-shaped bacterium that attaches itself to the surface of mucus-secreting cells of the stomach lining. About 50 percent of people over age 60 are infected with H. pylori, and most of them have no symptoms. But about 15 to 20 percent of people who have the bacterium develop a peptic ulcer.
WARNING!
Blood in the Stool
Internal bleeding (such as from the upper part of the small intestine or the stomach) may occur in small amounts and is not always obvious because the blood passes through the intestines slowly and your body partially digests it. The partially digested blood is loose, sticky, foul-smelling, and black (because blood oxidizes when it is exposed to air). See a doctor immediately if you pass black stool—it may be a sign of a peptic ulcer (see page 755), stomach cancer (see below), or another disorder of the esophagus, stomach, or intestines.
Bright red blood in the stool usually indicates blood that is traveling through the digestive tract rapidly or indicates bleeding at the end of the colon. See your doctor immediately if you pass bright red blood. Call 911 or your local emergency number or go to the nearest hospital emergency department immediately if the bleeding is excessive.
Gastrojejunostomy
A gastrojejunostomy is a surgically created connection between the stomach and the jejunum (the middle section of the small intestine) sometimes used for treating duodenal ulcers. The doctor seals the duodenum at the opening to the stomach, allowing gastric acid to enter the jejunum rather than the duodenum, where it could irritate the ulcer and cause it to bleed.
Cancer of the Stomach
Cancerous cells can develop anywhere in the stomach and are likely to spread to other parts of the body. Because the symptoms of stomach cancer are similar to those of other, less serious, digestive problems, it is difficult to detect stomach cancer early. It is thought that