A duodenal or peptic ulcer is an open sore in the intestine wall.

A GP will almost certainly suspect an ulcer when presented with the symptoms, but will confirm it with a gastroscope where a flexible camera is passed down the throat. This instrument produces very clear pictures that allow rapid diagnosis, and they can also take small samples to find out if the duodenal ulcer has been caused by H pylori the Helicobacter pylori bacterium.

Several other tests can also be used to detect the presence of H pylori:

  • A stool antigen test. A small sample of faeces is tested for the presence of H pylori antigens, which are proteins made by or found on the surface of the bacterium.
  • A urea breath test. H pylori has the ability to split urea into carbon dioxide and ammonia. When you drink urea labelled with an isotope of carbon, if your breath is analysed after10-30 minutes and is found to contain carbon dioxide labelled with the isotope, it’s a sure sign that H pylori is present in your system.

Treatment of a duodenal ulcer

Specific treatment depends on whether the duodenal ulcer is caused by the bacteria, the painkillers or a combination of both. Common treatments include:

  • Antibiotics can be prescribed to kill the H pylori. You will usually be given a combination of antibiotics. As with all antibiotics, it is important that the whole course is taken because the bacterial population can be hard to kill, and it’s important not to leave a few to re-populate the gut.
  • Antacids can neutralise the acid. Without the constant production of acid, the gut lining has a much better chance to heal. You may be prescribed a 1-2 month course of proton pump inhibitors (PPIs). These block proton pumps, proteins in the cell membrane of cells in the stomach wall that are responsible for producing stomach acid. Drugs called H2 blockers, which have a similar effect, may also be prescribed.
  • Switching from an NSAID to a non-NSAID painkiller such as paracetamol will help if your duodenal ulcer is a result of NSAID-related damage.

Treating a duodenal ulcer can take weeks; there are no short cuts as the ulcer needs time to heal. In the short-term, symptoms can be relieved by over-the-counter antacids and alginates. These antacids neutralise the acid (rather than preventing its production) and the alginates create a protective layer of slime that gives the duodenal ulcer a chance to repair.