What is a duodenal ulcer?

A duodenal ulcer is a raw area in the lining of the small intestine where the upper small intestine (duodenum) connects to the stomach. Duodenal ulcers tend to last a long time and they tend to recur.

How does it occur?

An ulcer occurs when the lining of the stomach or intestine is eaten away by stomach acid and digestive juices. The lining of the stomach and intestines is normally protected from stomach acids. However, under certain conditions the protection fails and ulcers can result.

The most common cause of duodenal ulcers is a type of bacteria called Helicobacter pylori, also called H. pylori. These bacteria cause about 90% of all duodenal ulcers.

Other common causes of ulcers include anti-inflammatory medications such as aspirin, ibuprofen, and naproxen. Stress also appears to contribute to ulcers. This includes both emotional stress and the sudden physical stress of a severe illness or injury.

Chemicals that seem to work with these common causes to produce ulcers include nicotine, caffeine, and alcohol.

People with a family history of duodenal ulcers are more likely to get ulcers. This problem is four times more common in men than in women. Ulcers occur most frequently between the ages of 20 and 60, with the most cases occurring between ages 40 and 50.

What are the symptoms?

Symptoms include:

• abdominal pain and heartburn or discomfort, usually 1 or 2 hours after a meal

• abdominal pain that interrupts sleep, especially in the early morning

• loss of appetite

• relief of abdominal pain by eating, drinking milk, or taking an antacid or ulcer treatment medication

• black, tarry stools

• bloody vomit.

How is it diagnosed?

To diagnose a duodenal ulcer, your health care provider will review your symptoms, ask about your medical history, and examine you.

Your provider may ask for a stool sample to check for bleeding. You may have blood tests to see if you have anemia from chronic bleeding to check for the H. pylori bacteria.

To locate the ulcer, you may have:

• An upper GI x-ray. For this test you will swallow liquid barium, which may allow your health care provider to see the ulcer on an x-ray.

• An endoscopy. This is a procedure in which you swallow a slim, lighted flexible tube that allows the health care provider to see the ulcer.

How is it treated?

The objectives of treatment are pain relief, healing of the ulcer, and prevention of complications. Treatment can also help prevent recurrence of the ulcer.

Your health care provider may prescribe:

• antibiotics to treat H. pylori

• antacids

• a medication to reduce the amount of acid in your stomach and intestine.

You will probably take the antibiotics for 1 to 2 weeks. You may take medicine to decrease acid for at least 6 weeks. Sometimes medicine needs to be taken for 6 to 12 months to prevent new ulcers.

Because stress can contribute to the development of duodenal ulcers, sometimes it is important to make changes in your lifestyle (see the section below titled 'How can I take care of myself?').

How long will the effects last?

Duodenal ulcers respond well to treatment but can recur. Taking the medications prescribed by your doctor helps reduce the chance that the ulcer will recur.

About 25% of people with duodenal ulcers develop complications. About 5% to 10% need surgery.

How can I take care of myself?

Follow the full treatment prescribed by your doctor. Keep your follow-up appointments. Also, you may want to make lifestyle changes such as:

• Avoid tobacco.

• Avoid alcohol.

• Avoid drugs such as aspirin, ibuprofen, and naproxen that cause stomach inflammation. (Ask your doctor if you can substitute acetaminophen.)

• Avoid strong tea, caffeinated and decaffeinated coffee, and colas.

• Eat balanced, nutritious meals. Several small meals may be better than two or three large ones.

• Learn how to manage stress

• Get plenty of rest.

• Exercise as recommended by your doctor.

• Seek professional help for dealing with events that cause anxiety.

If you continue having symptoms or your symptoms get worse, tell your doctor.

How can I help prevent duodenal ulcers?

• Follow your doctor's treatment plan and keep your follow- up appointments.

• Change your lifestyle in ways that might help prevent ulcers.