Successful Treatment of Duodenal Ulcer Amidst Other Conditions


A young 33-year-old woman presented to the hospital complaining of brittle hair and hair loss. She also experienced weakness, lethargy, and increased fatigue. Upon further inquiry, she mentioned upper abdominal heaviness, bloating, and occasional nausea, especially when fasting.

The woman avoided spicy, fatty, or fried foods but had long gaps between meals. Stress was cited as an additional factor contributing to her poor health.

Medical History
Symptoms began approximately 3 months prior, prompting the patient to seek medical evaluation. Blood tests revealed decreased hemoglobin levels (87 g/l), indicative of moderate anemia, and low ferritin (4 ng/ml) and iron (2.7 ng/ml) levels, consistent with iron-deficiency anemia. Urinalysis and thyroid hormone levels were within normal limits.

To determine the cause of anemia, the patient was referred for comprehensive testing. She had a history of chronic gastritis and duodenitis. Cesarean sections were performed in 2015 and 2017, with no blood transfusions. Iron supplements were taken during pregnancy. The patient had no harmful habits or allergies and did not suffer from tuberculosis, hepatitis B or C, syphilis, or HIV infection. Her grandparents had diabetes mellitus.

Examination Findings
Upon examination, the patient had a body temperature of 36.6°C, respiratory rate of 16 breaths per minute, heart rate of 87 beats per minute, blood pressure of 120/80 mmHg, and oxygen saturation of 99%. She weighed 50 kg at a height of 158 cm, with a body mass index (BMI) of 20 (underweight).

Pupils were equal and reactive to light. The skin was pale, joints non-tender, and there were no peripheral edemas. Peripheral veins were not dilated.

The thyroid gland was not enlarged or tender. Breast and submandibular lymph nodes were normal.

Nasal breathing was unobstructed, and the throat mucosa was pink without tonsil enlargement or exudates. Lung auscultation revealed normal breath sounds without crackles. Heart sounds were clear, and the pulse was rhythmic and adequately filled.

The abdomen was soft, slightly tender in the upper quadrants, with negative Mendel’s and Glinskiy’s signs. Liver and spleen were not palpable. The gallbladder was non-tender, and there were no signs of peritoneal irritation. Stool was regular, formed, and without blood or mucus.

Renal examination was unremarkable, with painless percussion of the lumbar region and normal urination.

Abdominal ultrasound showed minor changes in the pancreas. Stool analysis revealed high levels of clostridia and starch (+++), with minimal pathological flora concentration (+). No mucus or erythrocytes were present.

Pelvic ultrasound indicated signs of uterine adenomyosis and varicose veins.

Laboratory results from November showed:

  • Absence of Helicobacter pylori antibodies
  • Hemoglobin level of 109 g/l (positive trend but still low)
  • Normal levels of immunoglobulin A (IgA)
  • No gluten intolerance
  • Lactose intolerance (CC type)
  • Absence of helminth eggs or larvae in stool
  • No antibodies to Giardia, helminth complex, or ascarids
    Biochemical blood analysis and ECG were within normal limits.

Esophagogastroduodenoscopy (EGD) results revealed:

  • Superficial antral gastritis
  • Duodenitis
  • Duodenal ulcer (DU)
  • Scar deformation of the DU.


  • Duodenal ulcer disease (DU) at the scarring stage
  • Chronic gastritis unrelated to Helicobacter pylori infection, in unstable remission
  • Chronic duodenitis, in unstable remission
  • Biliary dyskinesia of the hypomotor type (slow bile outflow)
  • Small intestinal bacterial overgrowth
  • Secondary lactase deficiency
  • Moderate iron-deficiency anemia
  • Uterine adenomyosis

The patient was prescribed:

  • Esomeprazole – 20 mg twice daily (morning on an empty stomach and evening before meals) for 4 weeks
  • Rebamipide – one tablet three times daily (between meals) for 4 weeks to restore the gastric and duodenal mucosa
  • Lactazar – one capsule with lactose-containing meals (long-term)
  • Simethicone – 40 mg three times daily with meals for a week
  • Ferrous sulfate – one tablet twice daily with ferritin monitoring after a month (adjusting the dose based on results)

Additionally, she was advised to follow a specific diet for 4 weeks, including dividing meals into 5-6 servings, avoiding spicy, acidic, fatty, smoked, and fried foods, and consuming adequate protein (1 g per kg of weight). Due to low hemoglobin levels, she was recommended to prioritize red meat. To alleviate abdominal bloating, gas-producing foods such as legumes and baked goods were to be avoided.

The patient’s condition improved during treatment, with resolution of weakness, lethargy, fatigue, brittle hair, and hair loss. Nausea, heaviness, and abdominal bloating also subsided.

Follow-up esophagogastroduodenoscopy (EGD) on January 23, 2023, revealed:

  • Superficial antral gastritis
  • Scarred DU (fully scarred stage)
  • Duodenitis

Hemoglobin levels increased to 131 g/l, and ferritin and iron levels increased sevenfold (29.52 ng/ml and 14.9 ng/ml, respectively).

This clinical case illustrates a comorbid condition where multiple diseases coexist simultaneously. In such situations, proper diagnostic investigation and comprehensive therapy are crucial to ensure the maximum effectiveness in patient treatment.