What is Duodenal Ulcer and How to Diagnose?

By Shan Silva

The condition referred to as Duodenal Ulcer is one that typically announces itself as a sharp, severe pain in the upper part of the abdomen (the Epigastrium), appearing when a person is hungry and the stomach is empty.

Essentially, duodenal ulcers are caused by too much acid in the stomach; when the acid proves too strong for the protective inner lining of the duodenum (the part where the stomach joins the small intestine), it starts, in effect, burning a hole in the stomach wall. It is this crater, or ulcer, which results in pain, particularly when there is no food inside the stomach to use up the acid that is being produced.

Patients who develop duodenal ulcers usually tend to get relief from their pain by taking some milk, bland food or antacid tablets (like milk of magnesia), which can neutralize the excess acid. The danger of duodenal ulcers is that they erode the stomach wall - either perforating (so that the contents of the stomach leak out into the abdominal cavity) or eroding into a blood vessel, resulting in bleeding. Small amounts of bleeding manifest as Malaena (black discoloration of the stools) while a massive bleed can cause the patient to vomit blood or even die of hemorrhage.

To confirm the presence of a duodenal ulcer, doctors employ two main types of tests. Until a decade or two ago, the only method of diagnosing an, ulcer was by doing a Barium Meal - taking a series of X-rays after getting the patient to swallow a white liquid, Barium Sulphate. This substance clearly outlined the inside of the stomach, showing up the ulcer as a crater in the stomach wall.

Today, we have an instrument called the Gastroscope - a flexible, fibreoptic telescope which can be passed into the stomach through the mouth, and allows one to see clearly inside the stomach itself! The procedure is not painful, and does not require a general anesthetic- all the patient does is suck an anesthetic lozenge a few minutes beforehand to anesthetize the back of the throat before the gastroscope is passed in. Using the gastroscope, doctors can detect not only ulcers, but also growths like cancers inside the stomach. The instrument has made the diagnosis of stomach ulcers so much more accurate.

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