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.

Duodenal Ulcer
si1334_97870_1_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 are:

Risk Factors

Things that may raise the risk of this problem are:

  • H. pylori infection
  • Taking NSAIDs for a long time and at higher doses
  • Prior peptic ulcer disease
  • Tobacco use
  • Excessive alcohol intake

Symptoms

Some people may not have symptoms. Others may have problems that come and go. Food or fluids sometimes make symptoms better. Having an empty stomach may make symptoms worse.

Problems may be:

  • Gnawing pain that may:
    • Cause problems sleeping
    • Change when a person eats
    • Last for a few minutes or several hours
    • Feel like strong hunger pangs
    • Be relieved by taking antacids
  • Nausea and vomiting
  • Bloating
  • Burping
  • Loss of appetite
  • Weight loss

Ulcers can cause serious problems and severe belly pain. One problem is bleeding. This may result in:

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

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

Diagnosis

The doctor will ask about your symptoms and health history. A physical exam will be done.

Tests may include:

  • Blood test, stool test, or breath test to look for signs of H. pylori
  • Endoscopy to view the digestive system
  • Upper GI series to take pictures of the digestive system using contrast material to highlight abnormalities

Treatment

Treatment depends on what is causing the ulcer. Options are:

Medication

NSAIDs causing this problem may need to be stopped or changed. Medicine may also be given to protect the stomach against NSAID damage.

Other medicines may be:

  • Over-the-counter antacids
  • Antibiotics to treat an infection
  • Proton pump inhibitors to reduce stomach acid and protect the lining of the stomach and duodenum
  • H2 blockers to block a chemical in the body that signals the stomach to make acid
  • Medicine to coat the ulcer

Lifestyle Changes

Changes may need to be made, such as:

  • Not smoking
  • Limiting alcohol
  • Avoiding NSAIDs, such as ibuprofen

Surgery

People who are not helped by other methods may need surgery to:

  • Stop bleeding
  • Remove the ulcer
  • Remove part of the stomach or small intestine and creating a new connection between them
  • Take tissue from another part of the intestine and set it over the ulcer
  • Cut part of the nerve to reduce acid production

Prevention

Use NSAIDs as advised to lower the risk of this health problem.

RESOURCES:

American College of Gastroenterology
http://patients.gi.org

American Gastroenterological Association
http://www.gastro.org

CANADIAN RESOURCES

Canadian Association of Gastroenterology
https://www.cag-acg.org

Canadian Digestive Health Foundation
http://www.cdhf.ca

REFERENCES:

Fashner J, Gitu AC. Diagnosis and treatment of peptic ulcer disease and H. pylori infection. Am Fam Physician. 2015;91(4):236-242.

Lanas A, Chan FKL. Peptic ulcer disease. Lancet. 2017 Aug 5;390(10094):613-624.

Peptic ulcer disease. American College of Gastroenterology website. Available at: http://patients.gi.org/topics/peptic-ulcer-disease. Accessed October 21, 2020.

Peptic ulcer disease. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/peptic-ulcer-disease. Accessed October 21, 2020.

Peptic ulcers (stomach ulcers). National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: https://www.niddk.nih.gov/health-information/digestive-diseases/peptic-ulcers-stomach-ulcers. Accessed October 21, 2020.

Last reviewed September 2020 by EBSCO Medical Review Board Daniel A. Ostrovsky, MD  Last Updated: 10/21/2020