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.
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Upsets in the balance of stomach acid and digestive juices can lead to an ulcer. This can be caused by:
Helicobacter pylori (H. pylori) infectionUse of nonsteroidal anti-inflammatory drugs (NSAIDs)
Less common causes include:
Zollinger-Ellison syndromeRadiation therapyBacterial or viral infectionsAlcohol abuseTumorsOther medicines such as steroids or medicines to treat osteoporosis
Severe stress such as surgery,
trauma, head injury,
Factors that increase your chances of duodenal ulcer include: H. pylori
infectionTaking NSAIDs for a long time and at higher dosesPrior peptic ulcer diseaseCigarette smokingAlcohol abuse
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 sleepMay change when you eatMay last for a few minutes or several hoursFeels like unusually strong hunger pangsMay be relieved by taking antacidsNauseaVomitingLoss of appetiteBloatingBurpingWeight loss
Ulcers can cause serious problems and severe abdominal pain. One problem is bleeding. Bleeding symptoms may include:
Bloody or black, tarry stoolsVomiting what looks like coffee grounds or bloodWeaknessLightheadedness
A perforated ulcer is a break through the wall of the duodenum. It causes sudden and severe pain.
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
EndoscopyUpper GI seriesBiopsyMeasurement of bile acid in the small intestine
Talk to your doctor about the best treatment plan for you. Treatment options may include one or more of the following:
Your doctor may recommend:
Antibiotics if an infection is present or possibleOver-the-counter antacids
Proton pump inhibitors
Medications to coat ulcer
Medications to protect stomach against NSAID damage
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
Surgery and/or endoscopy may be recommended for: An ulcer that won't healRecurring ulcersA bleeding ulcerA perforated ulcerProblems with food passing out of stomach
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 for duodenal ulcers is rare, but it can greatly reduce acid production. Common procedures include: Removal of the ulcerRemoval of part of the stomach or small intestine, and creating a new connection between the themTying off the bleeding blood vesselTaking tissue from another part of the intestine and oversewing the ulcerCutting part of the nerve to reduce acid production
To reduce your chance of getting
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.
Meurer LN, Bower DJ. Management of
Am Fam Physician. 2002;65(7):1327-36.
Last reviewed April 2013 by Daus Mahnke, MD; Brian Randall, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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