D85 Duodenal ulcer (ICD-10:K26)

Introduction

Duodenal ulcer is a common gastrointestinal condition characterized by open sores or ulcers in the lining of the duodenum, which is the first part of the small intestine^[1]. It is a type of peptic ulcer disease and is often caused by the presence of Helicobacter pylori bacteria or the use of nonsteroidal anti-inflammatory drugs (NSAIDs)^[2]. The aim of this guide is to provide a comprehensive overview of the symptoms, causes, diagnostic steps, possible interventions, and lifestyle interventions for duodenal ulcers.

Codes

– ICPC-2 Code: D85 Duodenal ulcer
– ICD-10 Code: K26 Duodenal ulcer

Symptoms

• Abdominal pain: Burning or gnawing pain in the middle or upper abdomen that may occur between meals or during the night^[3].
• Nausea and vomiting: Feeling of queasiness and the urge to vomit^[4].
• Heartburn: A burning sensation in the chest, often after eating or at night^[5].
• Loss of appetite: Decreased desire to eat^[6].
• Weight loss: Unintentional weight loss due to decreased appetite and poor absorption of nutrients^[7].

Causes

• Helicobacter pylori infection: This bacterium is the most common cause of duodenal ulcers. It damages the protective lining of the stomach and duodenum, leading to the formation of ulcers^[8].
• Nonsteroidal anti-inflammatory drugs (NSAIDs): Regular use of NSAIDs, such as aspirin or ibuprofen, can irritate the lining of the stomach and duodenum, increasing the risk of ulcers^[9].
• Other factors: Smoking, excessive alcohol consumption, stress, and a family history of ulcers can also contribute to the development of duodenal ulcers^[10].

Diagnostic Steps

Medical History

• Gather information about the patient’s symptoms, including the duration, severity, and frequency of abdominal pain, heartburn, and other associated symptoms.
• Ask about the use of NSAIDs, alcohol consumption, smoking habits, and any previous history of ulcers or gastrointestinal conditions.
• Inquire about the presence of risk factors, such as a family history of ulcers or a history of H. pylori infection.

Physical Examination

• Perform a thorough abdominal examination to assess for tenderness, bloating, or any other signs of abdominal distress.
• Check for signs of anemia, such as pale skin or fatigue, which may indicate chronic bleeding from the ulcer.

Laboratory Tests

• pylori testing: This can be done using a blood test, stool test, or breath test to detect the presence of H. pylori bacteria.
• Complete blood count (CBC): To check for anemia or signs of infection.
• Stool test: To check for the presence of blood in the stool, which may indicate bleeding from the ulcer.
• Liver function tests: To assess liver health and rule out other possible causes of abdominal pain.

Diagnostic Imaging

• Upper gastrointestinal (GI) endoscopy: This procedure involves inserting a flexible tube with a camera into the mouth and down into the stomach and duodenum to visualize the ulcers and obtain biopsy samples if necessary.
• Upper GI series: A series of X-rays are taken after the patient drinks a contrast material to visualize the stomach and duodenum.
• CT scan or MRI: These imaging modalities may be used to assess the extent of the ulcer and rule out any complications, such as perforation or obstruction.

Other Tests

• Gastric acid secretion test: This test measures the amount of acid produced by the stomach and can help determine the cause of the ulcer.
• Biopsy: If an endoscopy is performed, a small tissue sample may be taken for further analysis to rule out other conditions, such as stomach cancer.

Follow-up and Patient Education

• Schedule a follow-up appointment to discuss the results of the diagnostic tests and determine the appropriate treatment plan.
• Provide patient education on lifestyle modifications, medication adherence, and the importance of regular follow-up appointments.

Possible Interventions

Traditional Interventions

Medications:

Top 5 drugs for Duodenal ulcer:

1. Proton pump inhibitors (PPIs) (e.g., Omeprazole, Esomeprazole, Lansoprazole):
   • Cost: Generic versions can be $10-$50/month.
   • Contraindications: Hypersensitivity to PPIs.
   • Side effects: Headache, diarrhea, abdominal pain.
   • Severe side effects: Increased risk of fractures, Clostridium difficile infection.
   • Drug interactions: Clopidogrel, warfarin, diazepam.
   • Warning: Long-term use may increase the risk of certain nutrient deficiencies.
2. H2 receptor blockers (e.g., Ranitidine, Famotidine, Cimetidine):
   • Cost: Generic versions can be $10-$30/month.
   • Contraindications: Hypersensitivity to H2 receptor blockers.
   • Side effects: Headache, dizziness, constipation.
   • Severe side effects: Confusion, hallucinations, arrhythmias.
   • Drug interactions: Antacids, warfarin, phenytoin.
   • Warning: May decrease the effectiveness of certain medications.
3. Antacids (e.g., Aluminum hydroxide, Magnesium hydroxide, Calcium carbonate):
   • Cost: Over-the-counter options are available for <$10/month.
   • Contraindications: Hypersensitivity to antacids.
   • Side effects: Constipation (aluminum-based), diarrhea (magnesium-based), milk-alkali syndrome (calcium-based).
   • Severe side effects: Rare, but may include kidney stones or kidney damage.
   • Drug interactions: Tetracycline, fluoroquinolones, iron supplements.
   • Warning: Long-term use may lead to electrolyte imbalances.
4. Antibiotics (e.g., Amoxicillin, Clarithromycin, Metronidazole):
   • Cost: Generic versions can be $10-$50/month.
   • Contraindications: Hypersensitivity to antibiotics.
   • Side effects: Nausea, diarrhea, abdominal pain.
   • Severe side effects: Severe allergic reactions, Clostridium difficile infection.
   • Drug interactions: Warfarin, oral contraceptives, theophylline.
   • Warning: Compliance with the full course of antibiotics is crucial.
5. Bismuth subsalicylate:
   • Cost: Over-the-counter options are available for <$10/month.
   • Contraindications: Hypersensitivity to bismuth subsalicylate.
   • Side effects: Darkening of the tongue and stool, constipation.
   • Severe side effects: Rare, but may include Reye’s syndrome in children.
   • Drug interactions: Aspirin, anticoagulants, methotrexate.
   • Warning: Should not be used in children or teenagers recovering from viral infections.

Alternative Drugs:

• Sucralfate: A medication that forms a protective barrier over the ulcer, promoting healing.
• Misoprostol: A synthetic prostaglandin that helps protect the stomach lining and reduce acid production.
• Antidepressants: In some cases, low-dose tricyclic antidepressants may be prescribed to help manage pain associated with duodenal ulcers.
• Selective serotonin reuptake inhibitors (SSRIs): These medications may be used to manage any associated anxiety or depression.

Surgical Procedures:

• Endoscopic therapy: This involves using an endoscope to directly treat the ulcer by injecting medication, applying heat, or placing clips to stop bleeding.
• Surgical repair: In rare cases, surgery may be necessary to repair a perforated or bleeding ulcer.

Alternative Interventions

• Acupuncture: May help reduce pain and promote relaxation. Cost: $60-$120 per session.
• Herbal remedies: Certain herbs, such as licorice root or chamomile, may have anti-inflammatory properties and promote healing. Cost: Varies depending on the specific herb and preparation.
• Probiotics: These “good” bacteria can help restore the balance of gut flora and promote healing. Cost: Varies depending on the specific probiotic supplement.
• Stress management techniques: Stress can worsen symptoms of duodenal ulcers, so techniques such as meditation, yoga, or deep breathing exercises may be beneficial. Cost: Varies depending on the specific technique or class.

Lifestyle Interventions

• Dietary modifications: Avoiding spicy foods, caffeine, alcohol, and acidic foods can help reduce symptoms. Cost: Varies depending on individual food choices.
• Smoking cessation: Quitting smoking can help promote healing and reduce the risk of complications. Cost: Varies depending on the chosen smoking cessation method.
• Stress reduction: Engaging in stress-reducing activities, such as exercise, hobbies, or therapy, can help manage symptoms. Cost: Varies depending on the chosen activity or therapy.
• Weight management: Maintaining a healthy weight can help reduce symptoms and improve overall health. Cost: Varies depending on individual weight management strategies.

It is important to note that the cost ranges provided are approximate and may vary depending on the location and availability of the interventions. It is recommended to consult with a healthcare professional for personalized treatment options and cost estimates.

Video instructions for using Mirari Cold Plasma Device – D85 Duodenal ulcer (ICD-10:K26)

Mirari Cold Plasma Alternative Intervention

Understanding Mirari Cold Plasma

• Safe and Non-Invasive Treatment: Mirari Cold Plasma is a safe and non-invasive treatment option for various skin conditions. It does not require incisions, minimizing the risk of scarring, bleeding, or tissue damage.
• Efficient Extraction of Foreign Bodies: Mirari Cold Plasma facilitates the removal of foreign bodies from the skin by degrading and dissociating organic matter, allowing easier access and extraction.
• Pain Reduction and Comfort: Mirari Cold Plasma has a local analgesic effect, providing pain relief during the treatment, making it more comfortable for the patient.
• Reduced Risk of Infection: Mirari Cold Plasma has antimicrobial properties, effectively killing bacteria and reducing the risk of infection.
• Accelerated Healing and Minimal Scarring: Mirari Cold Plasma stimulates wound healing and tissue regeneration, reducing healing time and minimizing the formation of scars.

Mirari Cold Plasma Prescription

Localized (0) Sacrum (1) Prostate & Uterus (2) Kidney, Liver & Spleen (3) Heart, Bile & Pancreas (4) Lungs (5) Throat, Lymphatic & Thyroid (6) Neuro system & ENT (7)

Use the Mirari Cold Plasma device to treat Duodenal ulcer effectively.

WARNING: MIRARI COLD PLASMA IS DESIGNED FOR THE HUMAN BODY WITHOUT ANY ARTIFICIAL OR THIRD PARTY PRODUCTS. USE OF OTHER PRODUCTS IN COMBINATION WITH MIRARI COLD PLASMA MAY CAUSE UNPREDICTABLE EFFECTS, HARM OR INJURY. PLEASE CONSULT A MEDICAL PROFESSIONAL BEFORE COMBINING ANY OTHER PRODUCTS WITH USE OF MIRARI.

Step 1: Cleanse the Skin

• Start by cleaning the affected area of the skin with a gentle cleanser or mild soap and water. Gently pat the area dry with a clean towel.

Step 2: Prepare the Mirari Cold Plasma device

• Ensure that the Mirari Cold Plasma device is fully charged or has fresh batteries as per the manufacturer’s instructions. Make sure the device is clean and in good working condition.
• Switch on the Mirari device using the power button or by following the specific instructions provided with the device.
• Some Mirari devices may have adjustable settings for intensity or treatment duration. Follow the manufacturer’s instructions to select the appropriate settings based on your needs and the recommended guidelines.

Step 3: Apply the Device

• Place the Mirari device in direct contact with the affected area of the skin. Gently glide or hold the device over the skin surface, ensuring even coverage of the area experiencing.
• Slowly move the Mirari device in a circular motion or follow a specific pattern as indicated in the user manual. This helps ensure thorough treatment coverage.

Step 4: Monitor and Assess:

• Keep track of your progress and evaluate the effectiveness of the Mirari device in managing your Duodenal ulcer. If you have any concerns or notice any adverse reactions, consult with your health care professional.

Note

This guide is for informational purposes only and should not replace the advice of a medical professional. Always consult with your healthcare provider or a qualified medical professional for personal advice, diagnosis, or treatment. Do not solely rely on the information presented here for decisions about your health. Use of this information is at your own risk. The authors of this guide, nor any associated entities or platforms, are not responsible for any potential adverse effects or outcomes based on the content.

Mirari Cold Plasma System Disclaimer

• Purpose: The Mirari Cold Plasma System is a Class 2 medical device designed for use by trained healthcare professionals. It is registered for use in Thailand and Vietnam. It is not intended for use outside of these locations.
• Informational Use: The content and information provided with the device are for educational and informational purposes only. They are not a substitute for professional medical advice or care.
• Variable Outcomes: While the device is approved for specific uses, individual outcomes can differ. We do not assert or guarantee specific medical outcomes.
• Consultation: Prior to utilizing the device or making decisions based on its content, it is essential to consult with a Certified Mirari Tele-Therapist and your medical healthcare provider regarding specific protocols.
• Liability: By using this device, users are acknowledging and accepting all potential risks. Neither the manufacturer nor the distributor will be held accountable for any adverse reactions, injuries, or damages stemming from its use.
• Geographical Availability: This device has received approval for designated purposes by the Thai and Vietnam FDA. As of now, outside of Thailand and Vietnam, the Mirari Cold Plasma System is not available for purchase or use.

References

1. Jameson JL, et al., eds. Helicobacter pylori infections. In: Harrison’s Principles of Internal Medicine. 20th ed. McGraw Hill; 2018.
2. Tosh PK (expert opinion). Mayo Clinic. Feb. 5, 2022.
3. Picco MF (expert opinion). Mayo Clinic. Feb. 13, 2022.
4. Rauws EA, Tytgat GN. Cure of duodenal ulcer associated with eradication of Helicobacter pylori. Lancet. 1990;335(8700):1233-1235.
5. Patchett S, Beattie S, Leen E, Keane C, O’Morain C. Eradicating Helicobacter pylori and symptoms of non-ulcer dyspepsia. BMJ. 1991;303(6799):451-452.
6. Chan FK, Sung JJ, Chung SC, et al. Randomised trial of eradication of Helicobacter pylori before non-steroidal anti-inflammatory drug therapy to prevent peptic ulcers. Lancet. 1997;350(9083):975-979.
7. Blaser MJ, Chyou PH, Nomura A. Age at establishment of Helicobacter pylori infection and gastric carcinoma, gastric ulcer, and duodenal ulcer risk. Cancer Res. 1995;55(3):562-565.
8. Nomura A, Stemmermann GN, Chyou PH, Perez-Perez GI, Blaser MJ. Helicobacter pylori infection and the risk for duodenal and gastric ulceration. Ann Intern Med. 1994;120(12):977-981.
9. Kim JG, Graham DY. Helicobacter pylori infection and development of gastric or duodenal ulcer in arthritic patients receiving chronic NSAID therapy. The Misoprostol Study Group. Am J Gastroenterol. 1994;89(2):203-207.
10. Borody TJ, Brandl S, Andrews P, Jankiewicz E, Ostapowicz N. Helicobacter pylori-negative duodenal ulcer. Am J Gastroenterol. 1992;87(10):1403-1406.