Alternate Names: Peptic ulcer; Ulcer - peptic; Ulcer - duodenal

Causes and Risks: 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 often associated with the presence of the bacteria Helicobacter pylori in the stomach. They are also associated with cigarette smoking. Risk factors are aspirin and NSAID use, family history of peptic ulcer, age greater than 30, and group O blood type. Duodenal ulcer occurs more frequently in men. The incidence is 7 out of 1000 people.

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.

Symptoms:

• abdominal pain
  • may wake the person at night
  • may be relieved by antacids or milk
  • may occur 2 to 3 hours after a meal
  • worse by not eating
• nausea
• vomiting
• weight loss
• fatigue
• dark tarry stools

• vomiting blood
• stools, bloody
• heartburn
• chest pain
• belching
• abdominal indigestion

Signs and Tests: An upper GI series shows duodenal ulcer. An esophagogastroduodenoscopy shows duodenal ulcer.

This disease may also alter the results of the following tests:

• stool guaiac
• Schilling test
• haptoglobin
• CEA
• amylase, urine
• amylase

Treatment: Ulcer-healing medications such as cimetidine, ranitidine, famotidine, or sucralfate are usually effective in most patients. Long-term therapy may be required.

Eliminating the presence of Helicobacter pylori with a combination of antibiotic therapy may heal ulcers and prevent recurrence.

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.

Prognosis: Duodenal ulcers tend to recur and get worse (remission and exacerbation). The recurrence rate is reduced if patients stop smoking and adhere to medical therapy for a year.

Complications:

• hemorrhage
• perforation of the intestine and peritonitis
• bowel obstruction

Call your health care provider if ulcer symptoms worsen, do not improve with treatment, or new symptoms develop.