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A duodenal ulcer is an open sore in the lining of the duodenum, the first part of the small intestine, that lies immediately distal (after) the stomach. The broad term for ulceration in the stomach or duodenal lining is peptic ulcer disease. Most of the causes of stomach ulcers are also responsible for the development of duodenal ulcers.
The duodenum has an inner epithelial lining, known as the mucosa. It is made up of simple columnar cells and also contains specialized cells that produce mucus and a few digestive enzymes.
With duodenal ulcers, the mucosa is eroded revealing the underlying layers like the submucosa and in severe cases, an ulcer may perforate the duodenal wall.
The duodenum has its own protective mechanisms against gastric acid in addition to a mucus barrier like the stomach. When acidity is detected in the duodenum, the pancreatic ducts secrete a combination of water and bicarbonate ions to neutralize the gastric acid in the duodenum.
Digestive hormones like secretin are also released into the blood stream to slow down gastric emptying thereby allowing the duodenum to cope with smaller quantities of gastric acid. The epithelial cells can also actively pump out hydrogen ions from the duodenal lumen, further reducing the acid content.
Duodenal ulcers are more common than stomach ulcers and are usually a solitary (single) ulcer. The ulcer usually forms close to the pyloric valve and more often occurs on the anterior duodenal wall. Please discuss with your doctor for further information.
The common symptoms of duodenal ulcer are:
There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.
If you have any signs or symptoms listed above or have any questions, please consult with your doctor. Everyone’s body acts differently. It is always best to discuss with your doctor what is best for your situation.
A duodenal ulcer arises when the protective mechanisms that protect the epithelial lining are compromised. The incoming acidic chyme from the stomach can erode the lining of the duodenum.
The most common causes of duodenal ulcers, like stomach ulcers, include H.pylori infection and the use of NSAIDs.
There are many risk factors for duodenal ulcer, such as:
The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.
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 stools (faeces), or in a breath test, or from a blood test, or from a biopsy sample taken during an endoscopy. See separate leaflet called Helicobacter Pylori and Stomach Pain for more details.
A 4- to 8-week course of a medicine that greatly reduces the amount of acid your stomach makes is usually advised. The most commonly used medicine is a proton pump inhibitor (PPI). These are a group (class) of medicines that work on the cells that line the stomach, reducing the production of acid.
They include esomeprazole, lansoprazole, omeprazole, pantoprazole and rabeprazole, and come in various brand names. Sometimes another class of medicines called H2 blockers is used. They are also called histamine H2-receptor antagonists but are commonly called H2 blockers.
H2 blockers work in a different way on the cells that line the stomach, reducing the production of acid. They include cimetidine, famotidine, nizatidine and ranitidine, and come in various brand names. As the amount of acid is greatly reduced, the ulcer usually heals. However, this is not the end of the story.
If your ulcer was caused by H. pylori
Nearly all duodenal ulcers are caused by infection with H. pylori. Therefore, a main part of the treatment is to clear this infection. If this infection is not cleared, the ulcer is likely to return once you stop taking acid-suppressing medication. Two antibiotics are needed.
In addition, you need to take an acid-suppressing medicine to reduce the acid in the stomach. This is needed to allow the antibiotics to work well. You need to take this combination therapy (sometimes called triple therapy) for a week.
One course of combination therapy clears H. pylori infection in up to 9 in 10 cases. If H. pylori is cleared, the chance of a duodenal ulcer returning is greatly reduced. However, in a small number of people, H. pylori infection returns at some stage in the future.
After treatment, a test to check that H. pylori has gone may be advised. If it is done, it needs to be done at least four weeks after the course of combination therapy has finished. In most cases, the test is negative meaning that the infection has gone. If it has not gone then a repeat course of combination therapy with a different set of antibiotics may be advised.
Some doctors say that for people with a duodenal ulcer, this confirmation test is not necessary if symptoms have gone. The fact that symptoms have gone usually indicates that the ulcer and the cause (H. pylori) have gone.
But, some doctors say it is needed to play safe. Your own doctor will advise if you should have it. (Note: a test to confirm that H. pylori has gone is usually always recommended if you have a stomach ulcer.)
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 (as mentioned above). This stops the stomach from making acid and allows the ulcer to heal.
However, in many cases the anti-inflammatory medicine is needed to ease symptoms of arthritis or other painful conditions, or aspirin is needed to protect against blood clots. In these situations, one option is to take an acid-suppressing medicine each day indefinitely. This reduces the amount of acid made by the stomach, and greatly reduces the chance of an ulcer forming again.
In the past, surgery was commonly needed to treat a duodenal ulcer. This was before it was discovered that H. pylori was the cause of most duodenal ulcers, and before modern acid-suppressing medicines became available. Surgery is now usually only needed if a complication of a duodenal ulcer develops such as severe bleeding or a hole (perforation).
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What are some lifestyle changes or home remedies that can help me manage duodenal ulcer?
The following lifestyles and home remedies might help you cope with duodenal ulcer:
If you have any questions, please consult with your doctor to better understand the best solution for you.