Why is duodenal ulcer pain relieved by food

Information from reference 4. Although H. Eradication of H. In addition, by inhibiting cyclooxygenase, NSAIDs inhibit the formation of prostaglandins and their protective cyclooxygenase-2—mediated effects i. Coexisting H. The annual risk of a life-threatening ulcer-related complication is 1 to 4 percent in patients who use NSAIDs long-term, with older patients at the highest risk.

The diagnosis of peptic ulcer disease is usually based on clinical features and specific testing, although it is important to be aware that individual signs and symptoms are relatively unreliable. Typical symptoms of peptic ulcer disease include episodic gnawing or burning epigastric pain; pain occurring two to five hours after meals or on an empty stomach; and nocturnal pain relieved by food intake, antacids, or antisecretory agents. A history of episodic or epigastric pain, relief of pain after food intake, and nighttime awakening because of pain with relief following food intake are the most specific findings for peptic ulcer and help rule in the diagnosis.

The natural history and clinical presentation of peptic ulcer disease differ in individual populations Table 2 6 , 15 — Weight loss precipitated by fear of food intake is characteristic of gastric ulcers. Incidence : Rare; most ulcers occur between eight and 17 years of age; duodenal ulcer up to 30 times more common than gastric ulcer.

Presentation : Patients may present with poorly localized abdominal pain. Testing : EGD should be performed if ulcer suspected; test- and-treat strategy not recommended; H. Complications : 25 percent of bleeding duodenal ulcers may be silent; perforation and penetration rare. Presentation : More likely to have painless ulcers; 50 percent present acutely e. Complications : Perforations associated with mortality three times higher than in younger patients; hemorrhagic complications more likely 20 percent from silent ulcers ; more likely to have continued bleeding and to need transfusions and surgery.

Cause : Breakdown of mucosal protectants as a result of stress leads to splanchnic hypoperfusion and ulcer; risk factors include mechanical ventilation longer than 48 hours, burns, coagulopathy, moderate to severe trauma, head or spinal cord injury, liver failure, and organ transplantation.

Presentation : Patients may be asymptomatic or may develop bleeding or perforation. Treatment : Early institution of PPI prophylaxis with oral or intravenous pantoprazole Protonix minimizes ulcer risk; histamine H 2 blockers and sucralfate Carafate are other options for prophylaxis. Presentation : Ulcer symptoms milder and may improve during pregnancy; vomiting is nocturnal or postprandial and worse in third trimester.

Testing : Ultrasonography and EGD are safe diagnostic tests. Complications : Infrequent; hypotension treated vigorously to minimize placental hypoperfusion; risk of miscarriage, abruption, and preterm labor if complications ensue.

Information from references 6 and 15 through If the initial clinical presentation suggests the diagnosis of peptic ulcer disease, the patient should be evaluated for alarm symptoms. Anemia, hematemesis, melena, or heme-positive stool suggests bleeding; vomiting suggests obstruction; anorexia or weight loss suggests cancer; persisting upper abdominal pain radiating to the back suggests penetration; and severe, spreading upper abdominal pain suggests perforation.

Patients older than 55 years and those with alarm symptoms should be referred for prompt upper endoscopy. Esophagogastroduodenoscopy EGD is more sensitive and specific for peptic ulcer disease than upper gastrointestinal barium studies and allows biopsy of gastric lesions.

Patients younger than 55 years with no alarm symptoms should be tested for H. Presence of H. The stool antigen test is less convenient but is highly accurate and can also be used to confirm H. Indicated in patients with evidence of bleeding, weight loss, chronicity, or persistent vomiting; those whose symptoms do not respond to medications; and those older than 55 years.

More than 90 percent sensitivity and specificity in diagnosing gastric and duodenal ulcers and cancers. Barium or diatrizoate meglumine and diatrizoate sodium Gastrografin contrast radiography double-contrast hypotonic duodenography. Indicated when endoscopy is unsuitable or not feasible, or if complications such as gastric outlet obstruction suspected. Diagnostic accuracy increases with extent of disease; 80 to 90 percent sensitivity in detecting duodenal ulcers. Useful only for initial testing sensitivity, 85 percent; specificity, 79 percent ; cannot be used to confirm eradication.

Urea breath test. Sensitivity, 95 to percent; specificity, 91 to 98 percent; can be used to confirm eradication PPI therapy should be stopped for two weeks before test.

Stool antigen test. Inconvenient but accurate sensitivity, 91 to 98 percent; specificity, 94 to 99 percent Can be used to confirm eradication.

Sensitivity, 70 to 96 percent; specificity, 77 to 85 percent Cannot be used to confirm eradication. Endoscopic biopsy. Information from references 1 , 19 , and If test results are positive for H. Further management is based on the endoscopic or radiologic diagnosis. Patients with persistent symptoms should be referred for endoscopy to rule out refractory ulcer and malignancy.

Algorithm for the treatment of peptic ulcer disease. Treatment of peptic ulcer disease should include eradication of H. The recommended duration of therapy for eradication is 10 to 14 days; however, shorter treatment courses regimens of one, five, and seven days are being assessed. Treatment duration is 10 to 14 days although courses lasting one to seven days have been reported to have comparable effectiveness 21 , Omeprazole Prilosec 20 mg two times daily or lansoprazole Prevacid 30 mg two times daily plus amoxicillin 1 g two times daily or metronidazole Flagyl mg two times daily if allergic to penicillin.

Treatment duration is four weeks for duodenal ulcer and eight weeks for gastric ulcer 80 to percent healing. Treatment duration is four weeks blockers Effectiveness similar to H 2. Duodenal ulcer: truncal vagotomy, selective vagotomy, highly selective vagotomy, partial gastrectomy. Gastric ulcer: partial gastrectomy with gastroduodenal or gastrojejunal anastomosis. Information from references 19 and 21 through Administration of an H 2 blocker or proton pump inhibitor for four weeks Table 4 19 , 21 — 25 induces healing in most duodenal ulcers.

Proton pump inhibitors provide superior acid suppression, healing rates, and symptom relief and are recommended as initial therapy for most patients. One meta-analysis of randomized controlled trials comparing proton pump inhibitors withH 2 blockers showed earlier pain control and better healing rates at four weeks for proton pump inhibitors 85 versus 75 percent.

Eradicating H. Repeated EGD with biopsy is recommended to confirm healing of gastric ulcers and to rule out malignancy. Maintenance therapy withH 2 blockers or proton pump inhibitors prevents recurrence in high-risk patients e. Refractory peptic ulcer disease i. Up to 25 percent of patients with gastric ulcers who continue to take NSAIDs may require proton pump inhibitor therapy for longer than eight weeks. Surgery is indicated in patients who are intolerant of medications or do not comply with medication regimes, and those at high risk of complications e.

Surgery should also be considered for patients who have a relapse during maintenance treatment or who have had multiple courses of medications. Surgical options for duodenal ulcers include truncal vagotomy and drainage pyloroplasty or gastrojejunostomy , selective vagotomy preserving the hepatic and celiac branches of the vagus and drainage, highly selective vagotomy division of only the gastric branches of the vagus, preserving Latarjet's nerve to the pylorus , or partial gastrectomy.

Surgery for gastric ulcers usually involves a partial gastrectomy. Peptic ulcer disease PUD is a common health issue in India owing to the habit of consumption of spicy food, undue intake of tea, coffee, tobacco and taking pain killers. The age-adjusted death rate is 5. Gastric ulcer and Duodenal ulcers are the 2 common types of peptic ulcers. Helicobacter pylori H. So, should you experience stomach pain recurrently or with cramps, talk to a GP for advice.

A long-standing gastric ulcer can cause life-threatening problems such as perforation, obstruction or cancer. What We treat Peptic ulcer disease PUD is a common health issue in India owing to the habit of consumption of spicy food, undue intake of tea, coffee, tobacco and taking pain killers. If you are a Mayo Clinic patient, this could include protected health information. If we combine this information with your protected health information, we will treat all of that information as protected health information and will only use or disclose that information as set forth in our notice of privacy practices.

You may opt-out of email communications at any time by clicking on the unsubscribe link in the e-mail. Your in-depth digestive health guide will be in your inbox shortly. You will also receive emails from Mayo Clinic on the latest health news, research, and care. Peptic ulcers occur when acid in the digestive tract eats away at the inner surface of the stomach or small intestine. The acid can create a painful open sore that may bleed. Your digestive tract is coated with a mucous layer that normally protects against acid.

But if the amount of acid is increased or the amount of mucus is decreased, you could develop an ulcer. A bacterium. Helicobacter pylori bacteria commonly live in the mucous layer that covers and protects tissues that line the stomach and small intestine.

Often, the H. It's not clear how H. It may be transmitted from person to person by close contact, such as kissing. People may also contract H. In addition to having risks related to taking NSAIDs , you may have an increased risk of peptic ulcers if you:. Alone, these factors do not cause ulcers, but they can make ulcers worse and more difficult to heal. You may reduce your risk of peptic ulcer if you follow the same strategies recommended as home remedies to treat ulcers.

It also may be helpful to:. Protect yourself from infections. It's not clear just how H. You can take steps to protect yourself from infections, such as H. This pain tends to respond well to medications or foods that reduce stomach acid, but as the effects of these wear off, the pain usually returns.

Abdominal pain from a duodenal ulcer may be worse when the stomach is empty, for example, between meals, at night, or first thing in the morning. Some people with these ulcers develop intolerances for specific foods. These foods may make a person feel sick, or they may make ulcer-related symptoms worse. Some people with peptic ulcers have no symptoms. A doctor may only discover the ulcer when checking for a different digestive disorder.

Anyone with symptoms of peptic ulcers should see a doctor. If symptoms are severe, seek urgent medical attention. A person has a higher risk of developing a peptic ulcer if they have an overgrowth of Helicobacter pylori H. This type of bacterial infection is common. While an H. Long-term use of certain medications, such as nonsteroidal anti-inflammatory drugs NSAIDs can also damage or irritate the lining and increase the risk of peptic ulcers.

If close family members have peptic ulcers, a person may be more likely to develop them. Doctors no longer think that alcohol, spicy foods, or rich foods cause ulcers. However, consuming them may make symptoms worse or slow the healing process.

The role of stress in the development of ulcers is uncertain. Some doctors believe that stress is a direct risk factor, while others do not.

In one small study , psychological stress increased the risk of developing peptic ulcers. However, the researchers believed that the link was partly indirect, that stress led to other risk behaviors, such as taking NSAIDs and smoking. Symptoms of peptic ulcers can be similar to those of other conditions, such as gallstones or gastroesophageal reflux disease, which is commonly called GERD.

Receiving a correct diagnosis is essential. They will also ask about symptoms and the location of any pain.