Duodenal Ulcers: Causes, Symptoms, and Treatment Options

Duodenal ulcer

Around mid-November, I underwent an upper gastrointestinal endoscopy at the hospital, which revealed a duodenal ulcer without Helicobacter pylori infection.
I have been taking Dexilant for nearly a month now, but I am experiencing some issues, including bloating and intermittent diarrhea (soft or watery stools, with episodes of diarrhea lasting several days).
This especially occurs after 9-10 PM and continues into the daytime.
I can feel my stomach moving (normally I don't feel this), and it happens intermittently from night to day.
I wake up and fall back asleep repeatedly, and whenever I feel the movement, I experience palpitations.
I consulted a cardiologist who said it is normal and likely sinus tachycardia, possibly due to heightened nervous sensitivity.
I would like to know if the duodenal ulcer could be caused by overly sensitive visceral nerves? Would a proton pump inhibitor (PPI) be effective? Should I consider changing my medication? Thank you.

Mr. Dai, 40~49 year old female. Ask Date: 2020/12/12

Dr. Chen Shidian reply Gastroenterology and Hepatology

PPIs may lead to an increase in small intestinal bacteria, resulting in diarrhea.
Please discuss this further with your attending physician.

Reply Date: 2020/12/12

More Info

Duodenal ulcers, also known as peptic ulcers, are open sores that develop on the lining of the duodenum, which is the first part of the small intestine. Understanding the causes, symptoms, and treatment options for duodenal ulcers is crucial for effective management and recovery.

Causes of Duodenal Ulcers
The primary causes of duodenal ulcers include:
1. Helicobacter pylori Infection: While you mentioned that your tests did not reveal the presence of H. pylori, it is the most common cause of duodenal ulcers. This bacterium can damage the protective lining of the stomach and duodenum, leading to ulcer formation.

2. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Regular use of NSAIDs, such as ibuprofen or aspirin, can irritate the stomach lining and lead to ulcer development.

3. Excessive Acid Production: Conditions that cause the stomach to produce too much acid, such as Zollinger-Ellison syndrome, can contribute to ulcer formation.

4. Lifestyle Factors: Smoking, excessive alcohol consumption, and high-stress levels can exacerbate ulcer symptoms and hinder healing.

5. Genetic Factors: A family history of ulcers may increase the likelihood of developing them.

Symptoms of Duodenal Ulcers
Common symptoms of duodenal ulcers include:
- Abdominal Pain: This is often described as a burning sensation and may occur a few hours after eating or during the night.

- Bloating and Gas: Many patients report feeling bloated, especially after meals.

- Nausea and Vomiting: Some individuals may experience nausea, and in severe cases, vomiting may occur.

- Changes in Bowel Habits: As you mentioned, diarrhea or changes in stool consistency can occur, particularly if the ulcer is affecting the digestive process.

- Heartburn: A burning sensation in the chest may accompany the abdominal discomfort.

Treatment Options
The treatment for duodenal ulcers typically involves a combination of medications and lifestyle changes:
1. Proton Pump Inhibitors (PPIs): Medications like omeprazole (Prilosec) or esomeprazole (Nexium) reduce stomach acid production, promoting healing of the ulcer. Given your current use of "得喜胃" (likely a PPI), it is essential to ensure that you are taking the medication as prescribed and for the recommended duration.

2. Antacids and H2-Receptor Antagonists: These can help neutralize stomach acid and provide symptomatic relief.

3. Antibiotics: If H. pylori is present, antibiotics are necessary to eradicate the infection.

4. Avoiding Irritants: Reducing or eliminating NSAIDs, alcohol, and smoking can significantly improve symptoms and promote healing.

5. Dietary Modifications: Eating smaller, more frequent meals and avoiding spicy or acidic foods may help alleviate symptoms.

Addressing Your Symptoms
Regarding your specific symptoms of bloating, diarrhea, and the sensation of intestinal motility, these could be related to several factors:
- Medication Side Effects: Some PPIs can lead to gastrointestinal side effects, including diarrhea and bloating. If these symptoms persist, it may be worth discussing with your healthcare provider whether a medication adjustment is necessary.

- Nervous System Sensitivity: Your mention of palpitations and anxiety could indicate that your body is reacting to the discomfort and stress associated with the ulcer. Stress management techniques, such as mindfulness or relaxation exercises, may help.

- Gastrointestinal Sensitivity: It is possible that your duodenal ulcer is causing increased sensitivity in your gastrointestinal tract, leading to heightened awareness of normal digestive processes.

Conclusion
In summary, while duodenal ulcers are primarily caused by H. pylori infection and NSAID use, various factors can contribute to their development and symptomatology. Your symptoms of bloating and diarrhea may be related to medication side effects or increased gastrointestinal sensitivity. It is essential to maintain open communication with your healthcare provider to assess your treatment plan and make any necessary adjustments. If symptoms persist or worsen, further evaluation may be warranted to rule out other underlying conditions.

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