Duodenal Ulcer

Definition

A duodenal ulcer is a sore in the lining of the intestine. The first part of the small intestine, just past the stomach, is called the duodenum.

Treatment may include antibiotics, medications that heal the ulcer and protect the intestine, and lifestyle changes. Surgery may be needed for ulcers that bleed, obstruct, perforate, or don't heal with other treatments.

Duodenal Ulcer

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Causes

Upsets in the balance of stomach acid and digestive juices can lead to an ulcer. This can be caused by:

• Helicobacter pylori (H. pylori) infection
• Use of nonsteroidal anti-inflammatory drugs (NSAIDs)

Less common causes include:

• Zollinger-Ellison syndrome
• Radiation therapy
• Bacterial or viral infections
• Alcohol abuse
• Tumors
• Other medicines such as steroids or medicines to treat osteoporosis
• Severe stress such as surgery, trauma, head injury, shock, or burns

Risk Factors

Factors that increase your chances of duodenal ulcer include:

• H. pylori infection
• Taking NSAIDs for a long time and at higher doses
• Prior peptic ulcer disease
• Cigarette smoking
• Alcohol abuse

Symptoms

Duodenal ulcers do not always cause symptoms. Symptoms may come and go. Food or fluids sometimes make symptoms better. Having an empty stomach may make symptoms worse. However, symptoms can occur at any time.

Symptoms may include:

• Gnawing pain:
  • May awaken you from sleep
  • May change when you eat
  • May last for a few minutes or several hours
  • Feels like unusually strong hunger pangs
  • May be relieved by taking antacids
• Nausea
• Vomiting
• Loss of appetite
• Bloating
• Burping
• Weight loss

Ulcers can cause serious problems and severe abdominal pain. One problem is bleeding. Bleeding symptoms may include:

• Bloody or black, tarry stools
• Vomiting what looks like coffee grounds or blood
• Weakness
• Lightheadedness

A perforated ulcer is a break through the wall of the duodenum. It causes sudden and severe pain.

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done.

Tests may include:

• Rectal exam and stool guaiac test
• Blood test, stool test, or breath test
• Endoscopy
• Upper GI series
• Biopsy
• Measurement of bile acid in the small intestine

Treatment

Talk to your doctor about the best treatment plan for you. Treatment options may include one or more of the following:

Prevention

To reduce your chance of getting H. pylori infection:

• Wash your hands after using the bathroom and before eating or preparing food.
• Drink water from a safe source.
• Don't smoke. Cigarette smoking increases the chances of getting an ulcer.

To reduce your chance of getting a duodenal ulcer from NSAIDs:

• Use other drugs when possible for managing pain.
• Take the lowest possible dose.
• Don't take drugs longer than needed.
• Don't drink alcohol while taking the drugs.
• Ask your doctor about switching to medicines less likely to cause ulcers. Talk to your doctor about taking other drugs to protect your stomach and intestine lining.
• Don't smoke. Cigarette smoking increases the chances of getting an ulcer.