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A duodenal ulcer is an open sore that occurs when the protective mucus lining the wall of the intestine breaks down. Bacteria, stomach acid and digestive enzymes can then damage the wall itself.

Stomach and duodenal ulcers are commonly called peptic ulcers. They can cause quite alarming and distressing symptoms but treatment is relatively straightforward and the need for surgery is rare.

What causes a duodenal ulcer?

Traditionally, it was thought that duodenal ulcers were caused by a combination of stress, smoking, diet and alcohol. While these may all contribute, in the 1990s it was discovered that 95% of duodenal ulcers were caused by a bacterium called Helicobacter pylori, or simply H. pylori. This bacterium is picked up in childhood but only causes problems for most people when they are adults.

H. pylori used to be present in everybody’s stomach. With better hygiene, however, the majority of people in the UK no longer become infected with it, although it is still very common in southern Europe, Asia and Africa. Most people who have this bacterium in their gut have no symptoms, but in certain circumstances, the bugs can break through the protective mucus and cause an ulcer.

Another contributory factor can be the long-term use of common painkillers such as aspirin, ibuprofen and diclofenac. These drugs belong to a group of painkillers known as non-steroidal anti inflammatory drugs (NSAIDs), which can irritate the gut lining and increase the risk of duodenal ulcer in some people.

Symptoms of duodenal ulcers

A recent survey in Sweden showed that 4% of the general population have either a stomach ulcer or a duodenal ulcer but it is common to show no symptoms whatsoever. Some people have mild symptoms which come and go, so they are ignored, but a duodenal ulcer is unlikely to heal without treatment.

Milder symptoms of a duodenal ulcer include a feeling of being full very quickly, feeling sick, heartburn, a bitter taste in the mouth and, in the longer term, weight loss. Symptoms that are more difficult to cope with include:

  • Pain in the abdomen/stomach region, typically just under the V of the ribcage, often described as a burning sensation. Pain may appear after eating, almost immediately with gastric ulcers and 2-3 hours later with duodenal ulcers, reflecting the time it takes for food to reach that part of the gut. Pain can sometimes occur as much as 5 hours later, which may result in disturbed sleep.
  • Passing blood, which makes the stools turn black with a tar-like consistency.
  • Vomiting blood, which can be bright red or take the appearance of small, dark granules (which are small blood clots).

Occasionally, the duodenal ulcer can extend right through the intestinal wall, and you develop a perforated ulcer. The gut contents can leak out through the hole, causing severe infection. A ruptured duodenal ulcer is a medical emergency and will require surgery.

Life after a duodenal ulcer

In the long-term, the vast majority of cases of duodenal ulcer are cured within 2 months with no long-term damage to the intestine wall except perhaps for slight scarring. This is unlikely to cause any symptoms.

Duodenal ulcers caused by H pylori rarely recur once the bacterial infection has been treated successfully. If your ulcer was due to NSAIDs, lifelong avoidance then becomes necessary to reduce your risk of developing another.

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