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:

    Medication

    Your doctor may recommend:

        
  • Antibiotics if an infection is present or possible
  • Over-the-counter antacids
  • Proton pump inhibitors
  • H-2 blockers
  • Medications to coat ulcer
  • Medications to protect stomach against NSAID damage

    • Lifestyle Changes

    You and your doctor will discuss lifestyle changes. These may include:

        
  • Quit smoking. Smoking worsens symptoms and slows healing.
  • Limit alcohol intake.
  • Avoid NSAIDs. This includes over-the-counter drugs like aspirin and ibuprofen.

    • Surgery and Endoscopy

    Surgery and/or endoscopy may be recommended for:

        
  • An ulcer that won't heal
  • Recurring ulcers
  • A bleeding ulcer
  • A perforated ulcer
  • Problems with food passing out of stomach

    • Endoscopy

    This may be done to stop bleeding. A thin, lighted tube is inserted down the throat into the stomach or intestine. Heat, electricity, epinephrine, or a substance called fibrin glue can then be applied to the area. This should stop the blood flow.

    Surgery

    Surgery for duodenal ulcers is rare, but it can greatly reduce acid production. Common procedures include:

        
  • Removal of the ulcer
  • Removal of part of the stomach or small intestine, and creating a new connection between the them
  • Tying off the bleeding blood vessel
  • Taking tissue from another part of the intestine and oversewing the ulcer
  • Cutting part of the nerve to reduce acid production

    • 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.