A duodenal ulcer is usually caused by an infection with a germ (bacterium) called Helicobacter pylori (H. pylori). A 4- to 8-week course of acid-suppressing medication will allow the ulcer to heal. In addition, a one-week course of two antibiotics plus an acid-suppressing medicine will usually clear the H. pylori infection. This usually prevents the ulcer from coming back. Anti-inflammatory medicines used to treat conditions such as arthritis sometimes cause duodenal ulcers. If you need to continue with the anti-inflammatory medicine then you may need to take long-term acid-suppressing medication.
What is a duodenal ulcer?
A duodenal ulcer is an ulcer that occurs in the lining in the part of the small intestine just beyond the stomach (the duodenum). An ulcer in the lining of the stomach is called a gastric ulcer.
There are separate leaflets called Non-ulcer Dyspepsia (Functional Dyspepsia), Stomach Ulcer (Gastric Ulcer) and Acid Reflux and Oesophagitis.
What are the symptoms of a duodenal ulcer?
- Pain in the upper tummy (abdomen) just below the breastbone (sternum) is the common symptom. It usually comes and goes. It may occur most before meals, or when you are hungry. It may be eased if you eat food, or take antacid tablets. The pain may wake you from sleep.
- Other symptoms which may occur include bloating, retching and feeling sick. You may feel particularly full after a meal. Sometimes food makes the pain worse.
- Complications occur in some cases and can be serious. These include:
- Bleeding ulcer. This can range from a trickle to a life-threatening bleed.
- Perforation. The ulcer goes right through (perforates) the wall of the first part of the small intestine (duodenum). Food and acid in the duodenum then leak into the abdominal cavity. This usually causes severe pain and is a medical emergency.
What are the treatments for a duodenal ulcer?
Lifestyle measures can improve symptoms, such as:
- Lose weight if you are overweight.
- Avoid any trigger foods, such as coffee, chocolate, tomatoes, fatty foods or spicy foods.
- Eat smaller meals and eat your evening meal 3-4 hours before going to bed.
- Stop smoking.
- Reduce alcohol consumption to recommended limits.
The most commonly used medicine is a proton pump inhibitor (PPI). See the separate leaflet called Indigestion Medication for more information.
Note: there have been studies recently questioning whether long-term PPI use may have an association with stomach cancer. As more research needs to be carried out, current advice is that PPIs should be taken at the lowest dose and for the shortest length of time. You may find you are able to take PPIs just occasionally rather than daily. However, if you find that other medicines haven't helped and you have symptoms which are persisting, you are currently advised to carry on taking your PPI medication until advised otherwise by your doctor.
If your ulcer was caused by H. pylori
Nearly all duodenal ulcers are caused by infection with H. pylori. See the separate leaflet called Helicobacter Pylori for more information.
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 (see above).
Surgery is now usually only needed if a complication of a duodenal ulcer develops, such as severe bleeding or a hole (perforation).
What causes duodenal ulcers?
There is normally a balance between the amount of acid that you make and the mucous defence barrier. An ulcer may develop if there is an alteration in this balance, allowing the acid to damage the lining of the stomach or duodenum. Causes of this include the following:
Infection with H. pylori
Infection with H. pylori is the cause in about 19 in 20 cases of duodenal ulcer. More than 1 in 4 people in the UK become infected with H. pylori at some stage in their lives. See the separate leaflet called Helicobacter Pylori for more information.
Anti-inflammatory medicines - including aspirin
Anti-inflammatory medicines are sometimes called non-steroidal anti inflammatory drugs (NSAIDs). These medicines sometimes affect the mucous barrier of the duodenum and allow acid to cause an ulcer.
Other causes and factors
Other causes are rare. For example, the Zollinger-Ellison syndrome. In this rare condition, much more acid than usual is made by the stomach.
Other factors such as smoking, stress and drinking heavily may possibly increase the risk of having a duodenal ulcer. However, these are not usually the underlying cause of duodenal ulcers.
What tests may be done?
- 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 stool (faeces), or in a breath test, or from a blood test, or from a biopsy sample taken during an endoscopy. See the separate leaflet called Helicobacter Pylori for more details.
Further reading and references
Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management; NICE Clinical Guideline (Sept 2014 - last updated October 2019)
Graham DY; History of Helicobacter pylori, duodenal ulcer, gastric ulcer and gastric cancer. World J Gastroenterol. 2014 May 1420(18):5191-204. doi: 10.3748/wjg.v20.i18.5191.
Dyspepsia - proven peptic ulcer; NICE CKS, October 2019 (UK access only)