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(Peptic Ulcer of the Duodenum)
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.
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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) infection
- Use of nonsteroidal anti-inflammatory drugs (NSAIDs)
Less common causes include:
Factors that may increase the chances of a duodenal ulcer:
- H. pylori infection
- Taking NSAIDs for a long time and at higher doses
- Prior peptic ulcer disease
- Cigarette smoking
- Excessive alcohol intake
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:
- 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
- Loss of appetite
- 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
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:
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 possible
- Over-the-counter antacids
- Proton pump inhibitors
- H2 blockers
- Medications to coat the 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 common over-the-counter drugs like aspirin and ibuprofen.
Surgery and Endoscopy
Surgery and/or endoscopy may be recommended for:
- An ulcer that will not heal
- Recurring ulcers
- A bleeding ulcer
- A perforated ulcer
- Problems with food passing out of stomach
An upper GI endoscopy 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 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
To help reduce the chances of H. pylori infection:
- Wash your hands after using the bathroom and before eating or preparing food.
- Drink water from a safe source.
- Do not smoke . Cigarette smoking increases the chances of getting an ulcer.
To help reduce the chances of a duodenal ulcer from NSAIDs:
- Use other drugs when possible for managing pain.
- Take the lowest possible dose.
- Do not take drugs longer than needed.
- Do not drink alcohol while taking the drugs.
- Ask your doctor about switching to medications less likely to cause ulcers. Talk to your doctor about taking other drugs to protect your stomach and intestine lining.
- Do not smoke. Cigarette smoking increases the chances of getting an ulcer.
American College of Gastroenterology
American Gastroenterological Association
Canadian Association of Gastroenterology
Canadian Digestive Health Foundation
Fashner J, Gitu AC. Diagnosis and treatment of peptic ulcer disease and H. pylori infection. Am Fam Physician. 2015;91(4):236-242.
Peptic ulcer disease. American College of Gastroenterology website. Available at: http://patients.gi.org/topics/peptic-ulcer-disease. Accessed April 4, 2018.
Peptic ulcer disease. American Gastroenterological Association website. Available at: http://www.gastro.org/attachments/6522/All%5FPepticUlcerDisease%5F2017.pdf. Updated July 2017. Accessed April 4, 2018.
Peptic ulcer disease. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T116374/Peptic-ulcer-disease . Updated April 2, 2018. Accessed April 4, 2018.
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 April 4, 2018.
- Reviewer: EBSCO Medical Review Board Daus Mahnke, MD
- Review Date: 03/2018
- Update Date: 05/07/2014