Duodenal ulcer

What is a duodenal ulcer?

A duodenal ulcer is an ulcer that occurs in the lining in the part of the small intestine just beyond the stomach (the duodenum). An ulcer in the lining of the stomach is called a gastric ulcer. The term 'peptic ulcer' is an umbrella term which includes both gastric and duodenal ulcers.

There are separate leaflets called Non-ulcer Dyspepsia (Functional Dyspepsia), Stomach Ulcer (Gastric Ulcer) and Acid Reflux and Oesophagitis.

How do duodenal ulcers form?

Duodenal ulcers form when there is a break in the lining (epithelium) of the duodenum (part of the small intestine within the digestive system).

What causes duodenal ulcers?

There is normally a balance between the amount of acid that you make and the mucous defence barrier. An ulcer may develop if there is an alteration in this balance, allowing the acid to damage the lining of the stomach or duodenum. Causes of peptic ulcers include the following:

Infection with H. pylori

Infection with H. pylori bacteria is the cause in about 19 in 20 cases of duodenal ulcer. More than 1 in 4 people in the UK become infected with H. pylori at some stage in their lives. See the separate leaflet called Helicobacter Pylori for more information.

Anti-inflammatory medicines - including aspirin

Anti-inflammatory medicines are sometimes called non-steroidal anti-inflammatory drugs (NSAIDs). These medicines sometimes affect the mucous barrier of the duodenum and allow acid to cause an ulcer.

Other causes and factors

Other causes are rare. For example, the Zollinger-Ellison syndrome. In this rare condition, much more acid than usual is made by the stomach.

Other factors such as smoking, stress and drinking heavily may possibly increase the risk of having a duodenal ulcer. However, these are not usually the underlying cause of duodenal ulcers.

Duodenal ulcer symptoms

• Pain in the upper tummy (abdomen) just below the breastbone (sternum) is the common symptom. It usually comes and goes. It may occur most before meals, or when you are hungry. It may be eased if you eat food, or take antacid tablets. The pain may wake you from sleep.

• Other symptoms which may occur include bloating, retching and feeling sick. You may feel particularly full after a meal. Sometimes food makes the pain worse.

• Complications occur in some cases and can be serious. These include:
  

  • Bleeding ulcer. This can range from a trickle to a life-threatening bleed.

  • Perforation. The ulcer goes right through (perforates) the wall of the first part of the small intestine (duodenum). Food and acid in the duodenum then leak into the abdominal cavity. This usually causes severe pain and is a medical emergency requiring surgery.

What tests may be done?

• Gastroscopy (endoscopy) is the test that can confirm a duodenal ulcer. In this test a doctor or nurse looks inside your stomach and the first part of your small intestine (duodenum). They do this by passing a thin, flexible telescope down your gullet (oesophagus). They can see any inflammation or ulcers.

• A test to detect the H. pylori germ (bacterium) is usually done if you have a duodenal ulcer. If H. pylori is found then it is likely to be the cause of the ulcer. Briefly, it can be detected in a sample of stool (faeces), or in a breath test, or from a blood test, or from a biopsy sample taken during an endoscopy. See the separate leaflet called Helicobacter Pylori for more details.

What are the treatments for a duodenal ulcer?

General advice

Lifestyle measures can improve symptoms, such as:

• Lose weight if you are overweight.

• Avoid any trigger foods, such as coffee, chocolate, tomatoes, fatty foods or spicy foods.

• Eat smaller meals and eat your evening meal 3-4 hours before going to bed.

• Stop smoking.

• Reduce alcohol consumption to recommended limits.

Acid-suppressing medication

The most commonly used medicine is a proton pump inhibitor (PPI) to reduce the amount of acid in your stomach. See the separate leaflet called Indigestion Medication for more information.

Note: there have been studies recently questioning whether long-term PPI use may have an association with stomach cancer. As more research needs to be carried out, current advice is that PPIs should be taken at the lowest dose and for the shortest length of time. You may find you are able to take PPIs just occasionally rather than daily. However, if you find that other medicines haven't helped and you have symptoms which are persisting, you are currently advised to carry on taking your PPI medication until advised otherwise by your doctor.

If your ulcer was caused by H. pylori

Nearly all duodenal ulcers are caused by infection with H. pylori. See the separate leaflet called Helicobacter Pylori for more information.

If your ulcer was caused by an anti-inflammatory medicine

If possible, you should stop the anti-inflammatory medicine. This allows the ulcer to heal. You will also normally be prescribed an acid-suppressing medicine for several weeks (see above).

Surgery

Surgery is now usually only needed if a complication of a duodenal ulcer develops, such as severe bleeding or a hole (perforation).

Are duodenal ulcers dangerous?

Yes - they can be if they burst (perforate) - this needs emergency surgery and can be life-threatening.