Duodenal Ulcer – Symptoms, Causes and Treatment


Ulcers often occur within the duodenum, usually in the first part just beyond the stomach which is called the duodenal cap. Ulcers can come in all shapes and sizes. Image 1 shows a single white-based ulcer. Image 2 shows numerous small ulcers scattered across the duodenal cap. Image 3 demonstrates a huge duodenal ulcer almost filling the cap. Note the brownish areas across the whitish base which is caused by some old blood. Some fresh bleeding is seen at the edge. Duodenal ulcers are caused by the bacteria, Helicobacter pylori, or by arthritis medications such as Advil, Motrin, Naprosyn, aspirin and many others. All of these ulcers healed under appropriate therapy.

Duodenal ulcers usually occur in younger people, while gastric ulcers occur in older age groups. It is still not clear what, if any, role stress plays in the development of ulcers. Alcohol and diet are not felt to play a very important role in the formation of ulcers. Some ulcers are caused by an organism called Helicobacter pylori, some are due to medications, and a few are caused by stomach or intestinal cancer. Therefore, treatment and long-term outcome depends on the cause of the ulcer.


Pain in the upper abdomen just below the sternum (breastbone) 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 medicines. The pain may wake you from sleep.

Symptoms of ulcer disease are variable. Many ulcer patients experience minimal indigestion or no discomfort at all. Some report upper abdominal burning or hunger pain one to three hours after meals and in the middle of the night. These pain symptoms are often promptly relieved by food or antacids. The pain of ulcer disease correlates poorly with the presence or severity of active ulceration. Some patients have persistent pain even after an ulcer is completely healed by medication.


Cigarette smoking not only causes ulcer formation, but also increases the risk of ulcer complications such as ulcer bleeding, stomach obstruction and perforation. Cigarette smoking is also a leading cause of ulcer medication treatment failure.

A duodenal ulcer is caused when the lining of the stomach is eaten away by stomach acid and digestive juices. A type of bacteria called Helicobacter pylori, also called H. pylori, commonly causes this. Other common causes of duodenal ulcers include anti-inflammatory medications such as aspirin and ibuprofen, stress, nicotine, caffeine, and alcohol use.

H pylori infection is generally regarded as the most important etiologic factor in the development of duodenal ulcer. Most authors regard H pylori as the cause of 85-95% of duodenal ulcers. All evidence supports the assertion that H pylori is the major cause of duodenal ulcer.

The most common cause of such damage is infection of the stomach with a bacterium called Helicobacter pylori (H.pylori). Most people with peptic ulcers have this organism living in their gastrointestinal (GI) tract. On the other hand, many people have this organism living in their GI tract but they don’t get an ulcer.


If possible, you should stop the anti-inflammatory medicine. This allows the ulcer to heal. However, in many cases the medicine is needed to ease symptoms of arthritis or other painful conditions. One option is to take an acid-suppressing medicine each day. This reduces the amount of acid made by the stomach, and greatly reduces the chance of an ulcer forming again.