An erosion in the lining of the duodenum (first part of the small intestine, connecting to the stomach). See also gastric ulcer - benign .

Alternative Names

Peptic ulcer; Ulcer - peptic; Ulcer - duodenal

Causes, incidence, and risk factors

A duodenal ulcer is a type of peptic disease that is caused by an imbalance between acid and pepsin (an enzyme ) secretion and the defenses of the mucosal lining. The inflammation may be precipitated by aspirin and nonsteroidal anti-inflammatory medications (NSAIDs). Duodenal ulcers are commonly associated with the presence of the bacteria Helicobacter pylori in the stomach. Risk factors are aspirin and NSAID use, cigarette smoking , and older age. Duodenal ulcer has historically occurred more frequently in men, but more recent data suggest similar rates in both men and women. The lifetime prevalence of a peptic ulcer 5 to 10% and approaches 10 to 20% in patients who are Helicobacter pylori positive.

Signs and tests

An

esophagogastroduodenoscopy shows duodenal ulcer. An upper GI series shows duodenal ulcer. This disease may also alter the results of the following tests:

stool guaiac

hemoglobin

Treatment

Treatment often involves using a combination of medications. By using more than one kind of medication, multiple factors can be addressed: killing the

Helicobacter pylori bacteria, reducing acid levels, and providing protection to the duodenum. This combination strategy often provides the best chance of allowing the ulcers to heal and reducing the chance that the ulcers will come back. However, it is important for patients to take all of the medications exactly as prescribed. The medications may include:

antibiotics to kill

Helicobacter pylori

acid blockers (e.g., cimetidine, ranitidine, famotidine)

proton pump inhibitors (e.g., omeprazole)

medications that protect the tissue lining (e.g., sucralfate)

bismuth (may help protect the lining and kill the bacteria)

Long-term therapy may be required. Self-help measures can help -- avoid smoking ; avoid tea, coffee , alcohol, and caffeine containing soft drinks; and avoid aspirin. In addition, eat several small meals a day at regular intervals.

Expectations (prognosis)

Duodenal ulcers tend to recur if untreated. The recurrence rate is reduced if patients are treated and eradicate Helicobacter pylori. Symptoms also improve if dietary modifications occur and if patients stop smoking .

Complications

hemorrhage

perforation of the intestine and

peritonitis

bowel obstruction

Calling your health care provider

Call your health care provider if

ulcer symptoms worsen, do not improve with treatment, or new symptoms develop.

Prevention

Avoiding use of aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) may be helpful for people with a history of ulcers . Antibiotics may be effective treatment and prevention for ulcers caused by Helicobacter pylori .