Duodenal ulcer

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Peptic ulcer is ulceration of the mucus coming to contact with acid and pepsin. Incidence is very high in India, particularly in Kerarl and Tamil nadu. Patients whose symptoms are like peptic ulcer on endoscopy are lablled as non-ulcer dyspepsia now a days it is also termed as Acid-peptic disease.

Duodenal ulcer remains a major health problem. 


Average age at the time of onset is around 33 years. It is four times more common in males than that in females. It is also 4-5 times more ommon than gastric ulcer. About 95% of duodenal ulcer occur in the duodenal cap. i.e. first 5 cms of duodenum. The ulceration varies from few millimetres to 1-2 cms in diameter.


Etio-Pathology


Heridity has a role to play. Peptic ulcer is higherr prevalence in Blood group 'O'. Mucosal injury and ulceration occurs with alcohol, chillies, excessive tea, coffee, corticosteroids, aspirin, salicylate, indomethacin, naproxen, ibuprofen, bile salts, excessive smoking, mental strain etc., Non steroid anti-inflammatory drugs decrease perception of pain so they may cause silent ulcer with complications of haemorrhage and perforation as initial symptom Helicobacter pylori infection also causes peptic ulcer.


The margins are sharp but the surrounding mucosa is often inflammed and oedematous. It extends atlease through the mucous mebrane, often through to then serosa and into the pancreas. The base consists of granulation tissue and fibrous tissue representing healing and continuing digestion.


Clinical features


There is burning, cramp like aching or moderate, located over a small area near the midline in the epigastrium, near lower end of sternum. The pain may radiate to the costal margins, into the back or rarely to the right shoulder. Nausea may be present. Vommitings of small quantities of highly acidic gastric juice may occur. 


The pain usulally occurs an hour after meal. It is usually absent before breakfast. Worseness as the day progresses and may be most severe between 12 midnight and 2 a.m. It is relieved by food, a cup full of milk, alkalies and vomiting. Trauma, infection, stress & strain are precipitating factors.


Spontaneous remisssions and exacerbations are common. There is superficial & deep epigastric tenderness, voluntary muscle guarding and spasm overr the duodenal bulb. Gastric analysis shows acid in all cases and hypersecretion in some. on X-ray(Barium meal) or endoscopy. ulcer crater can be seen.

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