Duodenal Ulcer

(Peptic Ulcer of the Duodenum)

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 include:

Risk Factors

Factors that may increase your chance of duodenal ulcer include:
  • H. pylori infection
  • Taking NSAIDs for a long time and at higher doses
  • Prior peptic ulcer disease
  • Cigarette smoking
  • Alcohol use disorder

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:

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 common 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
EndoscopyThis 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.SurgerySurgery 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

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Prevention

Tohelp 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 medications 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.

RESOURCES

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

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

CANADIAN RESOURCES

Canadian Association of Gastroenterology
http://cag-acg.org

Health Canada
http://www.hc-sc.gc.ca

References

Meurer LN, Bower DJ. Management of helicobacter pylori infection. Am Fam Physician. 2002;65(7):1327-1336.

Peptic ulcer disease. American College of Gastroenterology website. Available at: http://patients.gi.org/topics/peptic-ulcer-disease. Accessed April 29, 2013.

Peptic ulcer disease. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated April 22, 2013. Accessed April 29, 2013.

Peptic ulcers and H. pylori. National Digestive Diseases Information Clearinghouse website. Available at: http://www.niddk.nih.gov/health-information/health-topics/digestive-diseases/peptic-ulcer/Documents/hpylori%5F508.pdf. Updated April 30, 2012. Accessed April 29, 2013.

Understanding peptic ulcer disease. American Gastroenterological Association website. Available at: http://www.gastro.org/patient-center/digestive-conditions/peptic-ulcer-disease. Accessed April 29, 2013.

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