What is a duodenal ulcer?

A duodenal ulcer is a raw area in the lining of the small intestine where the upper small intestine (duodenum) connects to the stomach. Duodenal ulcers tend to last a long time and they often recur.

How does it occur?

A duodenal ulcer occurs when an area of the lining of the intestine is eaten away by stomach acid and digestive juices. The lining of the intestine is normally protected from stomach acids. However, under certain conditions the protection fails and ulcers can result.

The most common cause of duodenal ulcers is a type of bacteria called Helicobacter pylori, also called H. pylori. These bacteria cause about 90% of all duodenal ulcers.

Other common causes of ulcers include anti-inflammatory medications such as aspirin, ibuprofen, and naproxen. Stress also appears to contribute to ulcers. This includes both emotional stress and the sudden physical stress of a severe illness or injury.

Chemicals that seem to work with these common causes to produce ulcers include nicotine, caffeine, and alcohol.

People with a family history of duodenal ulcers are more likely to get ulcers. The problem is four times more common in men than in women. Most cases of ulcers occur between ages 40 and 50.

What are the symptoms?

Symptoms include:

• Abdominal pain and heartburn or discomfort, usually 1 or 2 hours after a meal
• Abdominal pain that interrupts sleep, especially in the early morning
• Loss of appetite
• Relief of abdominal pain by eating, drinking milk, or taking an antacid or ulcer medication
• Black, tarry stools
• Bloody vomit.

How is it diagnosed?

Your health care provider will review your symptoms, ask about your medical history, and examine you. You may have one or more of these tests:

• An upper GI x-ray (for this test you swallow liquid barium, which may allow your health care provider to see the ulcer on an x-ray)
• Blood tests to look for H. pylori bacteria
• Tests of a sample of your bowel movement to check for blood (which might come from a bleeding ulcer)
• A blood test for anemia (which may be sign of internal bleeding)
• An endoscopy, which may allow your provider to see the ulcer by inserting a thin, flexible tube with a tiny camera through your mouth to your upper digestive tract
• A biopsy, which involves taking a piece of tissue during an endoscopy and sending it to the lab for tests                            (this is CLO; another way to test for H. pylori).

How is it treated?

The goals of treatment are pain relief, healing of the ulcer, and prevention of complications. Treatment can also help prevent recurrence of the ulcer.

Your health care provider may prescribe:

• Antibiotics to treat H. pylori
• Antacids
• Medicine to reduce the amount of acid your stomach makes.

You will probably take the antibiotics for 1 to 2 weeks. You may take medicine to decrease acid for at least 6 weeks. Sometimes medicine needs to be taken for 6 to 12 months to prevent new ulcers.

Because stress can contribute to the development of duodenal ulcers, you may need to make changes in your lifestyle (see "How can I take care of myself?").

How long will the effects last?

Duodenal ulcers respond well to treatment but they can recur. You can help reduce the chance that an ulcer will recur by taking your medications.

About 25% of people with duodenal ulcers develop complications. About 5% to 10% need surgery.

How can I take care of myself?

• Follow the full treatment prescribed by your health care provider. Keep your follow-up appointments.
• You may want to make lifestyle changes such as:
• Avoid tobacco.
• Avoid alcohol.
• Avoid drugs that cause stomach inflammation, such as aspirin, ibuprofen, and naproxen. (Ask your provider if you can use acetaminophen instead.)
• Avoid strong tea, caffeinated and decaffeinated coffee, and colas.
• Eat balanced, nutritious meals. Several small meals may be better than two or three large ones.
• Learn how to manage stress. Seek professional help for dealing with events that cause anxiety and stress.
• Get plenty of rest.
• Exercise as recommended by your health care provider.
• If you continue having symptoms or your symptoms get worse, tell your health care provider.

How can I help prevent duodenal ulcers?

• Follow your health care provider's treatment plan and keep your follow-up appointments.
• Change your lifestyle in ways that might help prevent ulcers.