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Duodenal Ulcer – Causes, Symptoms and Treatment

A duodenal ulcer is a painful sore in the lining of the duodenum. It is most commonly caused by Helicobacter pylori infection or the use of non-steroidal anti-inflammatory drugs.

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Things worth knowing about "Duodenal Ulcer"

A duodenal ulcer is a painful sore in the lining of the duodenum. It is most commonly caused by Helicobacter pylori infection or the use of non-steroidal anti-inflammatory drugs.

What Is a Duodenal Ulcer?

A duodenal ulcer (medically: Ulcus duodeni) is an open sore that forms in the lining of the duodenum -- the first part of the small intestine, located just below the stomach. The protective mucous lining is eroded by stomach acid and digestive enzymes, leaving raw tissue exposed. Duodenal ulcers are the most common type of peptic ulcer and affect millions of people worldwide.

Causes

The main causes of duodenal ulcers are well established:

Helicobacter pylori infection: This bacterium colonizes the stomach lining, weakens its protective barrier, and is responsible for approximately 70–80% of all duodenal ulcers.
Non-steroidal anti-inflammatory drugs (NSAIDs): Medications such as ibuprofen, diclofenac, and aspirin inhibit the production of protective prostaglandins, making the mucosal lining vulnerable to acid damage.
Excess stomach acid production: In rare conditions such as Zollinger-Ellison syndrome, tumors cause the stomach to produce abnormally high amounts of acid.
Additional risk factors: Smoking, heavy alcohol consumption, chronic psychological stress, and genetic predisposition can all increase the risk of developing a duodenal ulcer.

Symptoms

Common symptoms of a duodenal ulcer include:

Fasting or hunger pain: A burning or cramping pain in the upper abdomen that typically occurs at night or when the stomach is empty, and is often relieved by eating.
Nausea and occasional vomiting
Heartburn and acid reflux
Loss of appetite and unintended weight loss
Complications: Bleeding (indicated by dark, tarry stools known as melena, or vomiting blood), perforation of the duodenal wall, or gastric outlet obstruction -- all of which require immediate medical attention.

Diagnosis

Several diagnostic tools are used to confirm a duodenal ulcer:

Upper endoscopy (gastroscopy): This is the gold standard. A thin, flexible tube with a camera is inserted through the mouth to visualize the ulcer directly. Tissue samples (biopsies) can be taken during the procedure.
Helicobacter pylori testing: This can be done via the ¹³C-urea breath test, stool antigen test, blood antibody test, or biopsy during endoscopy.
Blood tests: To check for signs of anemia or inflammation.

Treatment

Medical Therapy

Treatment is tailored to the underlying cause:

Helicobacter pylori eradication: If infection is confirmed, a standard triple therapy combining two antibiotics (e.g., clarithromycin and amoxicillin) with a proton pump inhibitor (PPI) is prescribed for 7–14 days. This approach achieves eradication in over 80% of cases.
Proton pump inhibitors (PPIs): Medications such as omeprazole or pantoprazole reduce stomach acid production and support mucosal healing.
H2-receptor antagonists: These may be used as an alternative or complement to PPIs in selected patients.
Discontinuation of NSAIDs: Where possible, offending pain medications should be stopped or replaced with more stomach-friendly alternatives.

Lifestyle Modifications

Quitting smoking and reducing alcohol intake
Stress management techniques
Dietary adjustments -- avoiding highly spiced, acidic, or fatty foods

Endoscopic and Surgical Treatment

In cases of complications such as active bleeding, perforation, or gastric outlet obstruction, endoscopic intervention or surgery may be necessary.

Prognosis

With appropriate treatment, duodenal ulcers typically heal completely. Successful eradication of Helicobacter pylori significantly reduces the risk of recurrence. If left untreated, ulcers can progress to serious and potentially life-threatening complications, making early diagnosis and treatment essential.

References

Laine L, Takeuchi K, Tarnawski A. Gastric mucosal defense and cytoprotection: bench to bedside. Gastroenterology. 2008;135(1):41–60.
Malfertheiner P, Megraud F, Rokkas T, et al. Management of Helicobacter pylori infection: the Maastricht VI/Florence consensus report. Gut. 2022;71(9):1724–1762.
Fashner J, Gitu AC. Diagnosis and Treatment of Peptic Ulcer Disease and H. pylori Infection. American Family Physician. 2015;91(4):236–242.

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