Duodenal Ulcers: Important Concepts And Home Remedies

 

 Duodenal ulcer is the result of acid-pepsin digestion of the mucosa. (Gastric hypersecretion is seen in most cases).

Causes of Duodenal Ulcers:

  1. Spicy diet, tea, coffee, etc.
  2. Excessive smoking, and alcohol habits, etc.
  3. Improper chewing (inadequate mastication)
  4. Endocrine factor – Zollinger Ellison syndrome multiple adenoma syndrome etc.
  5. Increased parietal cell mass.
  6. Hyperacidity
  7. Irregular dietary habit.
  8. Genetic factor.
  9. Endocrine factor – Zollinger Ellison syndrome multiple adenoma syndrome etc.
  10. Increased parietal cell mass.
  11. In some cases idiopathic.
  12. Improper chewing (inadequate mastication)

 

Common Sites of Ulcer Formation:

Ist part of the duodenum. Rarely posterior wall of 2nd part of the duodenum.

Pathology of Ulcers in the Body:

Acute lesions are frequently multiple and are less regularly distributed. Benign ulcer occurs only rarely on the greater curvature or on the anterior wall of the stomach.

A chronic duodenal ulcer never becomes malignant; a chronic gastric ulcer may in 0.5% of cases.]

Ulcers occurring in the stomach and duodenum may be acute or chronic, the difference being that a chronic ulcer penetrates the muscularis mucosae, whereas and acute ulcer or an erosion does not. Chronic ulcers occur with remarkable regularity in certain sites; in the stomach on the lesser curvature just above the angulus or less frequently at or near the pylorus, while duodenal ulcers occur within 1 cm. of the pylorus on the anterior or posterior wall.

 

Clinical Features and Duodenal Ulcers Symptoms:

  1. Pain – gradual onset, site – umbilicus, epigastrium, Pain in empty stomach, hunger pain, food relieves the pain after 2 to 3 hours, again pain starts.
  2. Burning sensation (heartburn) – acid eructation
  3. Vomiting – rare.
  4. Melaena – may be present ) passage of black, tarry stool
  5. Appetite – increases (food relief pain).

Signs of Ulcer Formation:

  1. Palpation – duodenal part is tender on deep palpation.
  2. Inspection – nothing abnormal
  3. Percussion – nothing abnormal.
  4. Inspection- nothing abnormal.
  5. Percussion – nothing abnormal.
  6. Auscultation – nothing abnormal.
  7. General – healthy or obese.

Investigations related to Duodenal ulcers:

  1. Barium meal X-ray – presence of an ulcer crater of the deformed duodenal cap or pyloric stenosis.

  2. Gastric function test – Augmented histamine test shows increase

    Hcl

    content of the gastric juice.

  3. Total night juice test – shows increased vagal activity

  4. Occult blood test in stool- positive

  5. Gastroscopy- may reveal ulcer in the stomach only.

  6. String test – may reveal the site of hemorrhage.

  7. E.S.R. may e raised.

Complications related to ulcer formation:

Prognosis :  

  1. Haematemesis and melaena.

  2. Shock.

  3. Perigastric adhesion.

  4. Pyloric stenosis.

  5. Perforation – peritonitis.

  6. Hourglass contracture.

Differential diagnosis of ulcers:

Duodenal ulcer is different from the chronic gastric ulcer, stone in the gall bladder or kidney and chronic appendicitis by its characteristic pain. Diagnosis can be confirmed best by X-ray (B-meal, cholecystograph, U.S.G., C.T. Scan, etc.) examination.

With careful dietetic treatment and regulate the mode of life the prognosis is quite favourable.

Management of a case of ulcers:

Here is the duodenal ulcers treatment-

(A) Medical Treatment :

  1. Rest to body, rest to mind and rest to ulcer
  2. Diet – should be bland and nutritive, such as soft rice, boiled fish or egg. Potatoes etc. Vitamin ‘C’, spic
  3. Antacids – Aluminium hydroxide gel and Magnesium oxide trisilicate (mostly useful). If the bowel habit is loose the former drug and if the bowel habit is constipated the latter drug is usually prescribed. When the bowel habit is normal both these drugs adequate combination should be given. 15 to 30 cc. of liquid antacid should be given 1 and 3 hours after meals and also at bedtime.
  4. Rest to body, rest to mind and rest to ulcer
  5. Smoking, tea, coffee, alcohol should be avoided; abstinence from these habits favour quick healing and reduces the chances of relapse.
  6. Food to be given every other hour or the third hour. Semisolid food in adequate quantity is to continue for several months.
  7. Rest to body, rest to mind and rest to ulcer

(B) Surgical Treatment:

 

    1. Recurrent haematemesis, melaena, perforation, etc
    2. When the patient cannot afford time for prolonged trial with medical treatment.
    3. A suspicion of malignancy
    4. Where the patient is not reliable.
    5. Pyloric stenosis.

Homoeopathic Remedies for Duodenal ulcers:

  1. Carbo vegetalis– Burning in stomach, spreading down to small or back and up to the shoulders,  Pain paroxysmal, takes away the breath. Bitter taste before and after eating. Vomiting of sour, bloody masses.

  2. Anacardium– Symptoms disappear while eating and return soon after. Pain as if a blunt plug were pressed into the intestines. Constant desire to eat. Which gives temporary cease. Confusion of mind and loss of memory.

  3. Lycopodium– Everything tastes sour. Heartburn, water brash, acidity. Great fullness in the stomach after taking a mere mouthful of food. The constant sense of fermentation in abdomen, much rumbling, particularly in left hypochondria. Constipation stool hard. Worse from 4 to 8 p.m.

  4. Colocynth – Frequent vomiting. Vomiting caused by pain, annoyance of distress may result in unbearable pain in any part of the body, causing vomiting Agonizing pain in the abdomen, only eased by bending double and pressing hard into the abdomen. Colic > by heat & pressure.

  5. Robinia – An excellent remedy for heartburn and acidity. Everything turns to acid. “The chief keynote of Robinia is acidity, esp. if the time of <is night>.

  6. Nux vomica– Putrid or bitter taste early in the morning. Frequent sour eructation. The region of the stomach is very sensitive to pressure. Cramp-like pain in stomach, with pressure, particularly after a meal. Water brash, heartburn.

Biochemic Remedies for ulcers:

  1. Calcarea sulph– Ulcer of the stomach, with gnawing pain circumscribed to a small spot.
  2. Natrum Phos – Ulceration of stomach or bowels, with vomiting of sour, acid fluids, or of a dark substance like coffee grounds
  3. Kali phos– Ulcer of the stomach, with ‘gone feeling’ in the stomach. The hungry feeling after taking food. Flatulence, with pain in left side, gas gathers about heart, causing distress
  4. Kali mur– Ulceration of stomach. The tongue is frequently coated white or grayish white. Tasteless or putrid erucatation, vomiting of sour, watery fluid or blood.
  5. Mag phos– Spasms and cramping of the stomach, with gastric ulcer, clean tongue. Ulcers, with nipping, gripping pains in stomach, gnawing pains in the stomach, relieved by hot drinks.

Home Remedies for Duodenal Ulcers:

What should be included n the duodenal ulcers diet? Given below-

  1. Taking bananas, honey, carrot juice and also raw cabbage is beneficial for ulcers.
  2. Fibre foods like fruits, oats and lentils are also useful.
  3. Tomatoes, watermelons as well as peaches can be taken .
  4. Vitamin A-containing foods are also superb for cases of ulcers.
  5. Avoid smoking and drugs like aspirin in the case of ulcers.

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