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Duodenal Ulcer

  • Cynthia M. Johnson, MA
Publication Type:


Duodenal Ulcer

(Peptic Ulcer of the Duodenum)


A duodenal ulcer is a sore in the lining of the intestine. The first part of the small intestine, just past the stomach, is called the duodenum.

Duodenal Ulcer.

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An imbalance of stomach acid and digestive juices can lead to an ulcer. This can be caused by:

  • Helicobacter pylori (H. pylori) infection
  • Use of nonsteroidal anti-inflammatory drugs (NSAIDs)

Less common causes are:

Risk Factors

Things that may raise the risk of a duodenal ulcer are:

  • H. pylori infection
  • Taking NSAIDs for a long time and at higher doses
  • Past peptic ulcer disease
  • Tobacco use
  • Excessive alcohol intake


Some people with ulcers do not have symptoms. Others may have problems that come and go. Food or fluids sometimes make symptoms better. Having an empty stomach may make symptoms worse.

Problems may be:

  • Gnawing pain that may:
    • Cause problems sleeping
    • Change when a person eats
    • Last for a few minutes or several hours
    • Feel like strong hunger pangs
    • Be relieved by taking antacids
  • Nausea and vomiting
  • Bloating
  • Burping
  • Loss of appetite
  • Weight loss

Ulcers can cause serious problems and severe belly pain. One problem is bleeding. This may result in:

  • Weakness
  • Light-headedness
  • Bloody or black, tarry stools
  • Vomiting that looks like coffee grounds or blood

A perforated ulcer is a break through the wall of the duodenum. It causes sudden and severe pain.


The doctor will ask about symptoms and past health. A physical exam will be done.

Tests may include:

  • Blood test, stool (poop) test, or breath test to look for signs of H. pylori
  • Endoscopy to view the digestive system
  • Upper GI series to take pictures of the digestive system using contrast material to highlight abnormalities


Treatment depends on what is causing the ulcer. Options are:


To lower the risk of getting an ulcer, use NSAIDs only as advised.


NSAIDs causing this problem may need to be stopped or changed. Medicine may also be given to protect the stomach against NSAID damage.

Other medicines may be:

  • Over-the-counter antacids
  • Antibiotics to treat an infection
  • Medicines to protect the stomach lining by reducing stomach acid
  • Medicine to coat the ulcer

Other Changes That May Help

Changes may need to be made, such as:

  • Not smoking
  • Limiting alcohol
  • Avoiding NSAIDs, such as ibuprofen


People who are not helped by other methods may need surgery to:

  • Stop bleeding
  • Remove the ulcer
  • Remove part of the stomach or small intestine and make a new connection between them
  • Take tissue from another part of the intestine and set it over the ulcer
  • Cut part of the nerve to reduce acid production




  • Lanas A, Chan FKL. Peptic ulcer disease. Lancet. 2017 Aug 5;390(10094):613-624.
  • Peptic ulcer disease. American College of Gastroenterology website. Available at: http://patients.gi.org/topics/peptic-ulcer-disease.
  • Peptic ulcer disease. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/peptic-ulcer-disease.
  • Peptic ulcers (stomach ulcers). National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: https://www.niddk.nih.gov/health-information/digestive-diseases/peptic-ulcers-stomach-ulcers.


  • Daniel A. Ostrovsky, MD
Last Updated:

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.