A duodenal ulcer is a type of peptic ulcer that can appear in the duodenum. The duodenum is the upper part of the small intestine that’s connected directly to the stomach where it empties into the intestines.

Peptic ulcers are sores that form when the protective mucus lining of the stomach or intestine is worn away.

Duodenal ulcers are diagnosed in 5–10% of people in the Western world. They’re usually caused by Heliobacter pylori (H. pylori) bacteria or by overusing nonsteroidal anti-inflammatory drugs (NSAIDs).

Read on to learn about the symptoms of duodenal ulcers, their most common causes and complications, and how a duodenal ulcer can be diagnosed and treated.

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Illustrated by Jason Hoffman

Pain around the abdomen is the most common symptom of a duodenal ulcer.

Duodenal ulcer pain can range from a light ache to a burning sensation coming from the stomach area. Pain may be more noticeable at night or after you haven’t eaten for a while.

Other symptoms of a duodenal ulcer can include:

  • feeling very full or bloated after a meal
  • persistent heartburn
  • feeling nauseated for no obvious reason

As a duodenal ulcer progresses, you may notice more severe symptoms. Contact a doctor if you have any of these symptoms:

  • throwing up after eating
  • throwing up blood that looks red or black
  • bloody or black poop
  • having trouble breathing
  • feeling lightheaded or disoriented
  • losing weight for no obvious reason
  • loss of appetite

Duodenal ulcers are a type of peptic ulcer. This means that they happen when the layer of mucus that lines your duodenum is damaged or penetrated by infectious substances or other materials that can damage this lining.

The two most common reasons for damage to this mucus lining include:

  • An overgrowth of H. pylori bacteria: You usually have a certain amount of H. pylori bacteria in your stomach and duodenum. But if they’re allowed to grow out of control, they can become infectious and damage the mucus lining of your duodenum. Infectious H. pylori bacteria can also be transmitted by contact with the saliva of someone who has it or by drinking water that’s overgrown with H. pylori.
  • Overuse of NSAIDs: Using NSAIDs like aspirin or ibuprofen too often can cause inflammation in your stomach and intestinal lining. Over time, inflammation can damage your mucus linings and cause ulcers.

Some other possible causes of duodenal ulcers include:

  • other bacterial and viral infections that affect the gastrointestinal (GI) tract
  • long-term use of medications like corticosteroids and antidepressants
  • complications of surgery on the stomach or small intestine
  • Zollinger-Ellison syndrome, a digestive condition that causes your stomach to produce too much acid
  • vascular insufficiency, which happens when blood doesn’t flow back to the heart properly
  • chemotherapy

Some factors that can increase your risk of developing a duodenal ulcer include:

  • smoking tobacco products
  • regularly drinking alcohol
  • having long-term stress
  • eating a lot of spicy foods

Untreated duodenal ulcers can cause complications that become increasingly hard to treat, including:

  • bleeding inside the intestines
  • perforation of the intestinal wall, which can cause infectious bacteria to leak into your body
  • bowel obstruction that makes it hard for your body to digest food

Some tests that a doctor might use to diagnose a duodenal ulcer include:

  • taking a history of symptoms, such as pain and reactions to food
  • a physical exam to look for other signs and sources of intestinal pain or blockage
  • upper endoscopy or esophagogastroduodenoscopy (EGD) to look for an ulcer in your duodenum
  • computed tomography (CT) scan to get detailed images of the duodenum and the surrounding tissues
  • barium swallow test that uses a brightly colored liquid in your GI tract to make an ulcer “light up” on X-rays
  • a biopsy of tissue from the duodenum to test for H. pylori bacteria
  • other diagnostic tests like a breath test, stool antigen test, or serological tests for ulcers caused by infections

Treatment for a duodenal ulcer depends on what’s causing the ulcer.

Some possible treatments include:

  • Antibiotics: Antibiotics like amoxicillin (Amoxil) may destroy overgrowths of H. pylori.
  • Proton-pump inhibitors (PPIs): PPIs like omeprazole (Prilosec) may help keep stomach acid from building up and causing ulcers.
  • Acid (histamine H-2) blockers: Famotidine (Pepcid) may stop acid from causing ulcers.
  • Antacids: Antacids may reduce stomach acidity and help prevent ulcers.
  • Sucralfate (Carafate): This medication may protect your stomach and duodenal mucus lining.

You can usually prevent a duodenal ulcer from returning by reducing your risk factors for an ulcer.

Here are some tips for preventing a duodenal ulcer:

  • Wash your hands regularly to help protect yourself from infections.
  • Use NSAIDs only as directed, or switch to other types of pain medications like acetaminophen (Tylenol).
  • Reduce how much you smoke or quit smoking. This can be difficult, but a doctor can help you build a cessation plan that works for you.
  • Reduce alcohol intake to 2 or fewer drinks a day, or stop drinking alcohol altogether.
  • Eat a nutritious diet rich in fruits and vegetables.

Here are some of the most frequently asked questions about duodenal ulcers.

What is the most common cause of a duodenal ulcer?

NSAID overuse is the most common cause of duodenal ulcers in the Western world.

Developments in hygiene practices and sewage treatment have made H. pylori much less common. But they are still a common cause of ulcers globally.

What does duodenal ulcer pain feel like?

Duodenal ulcer pain feels like a burning or gnawing feeling in the stomach area between your chest and belly button. This pain may feel like it never goes away and may feel more painful at night or a few hours after a meal.

What happens to an untreated duodenal ulcer?

An untreated duodenal ulcer may go away on its own if an H. pylori infection is reduced or if NSAID use decreases. But in many cases, an untreated ulcer can wear away at the lining of the duodenum and weaken it, increasing the risk of infectious material leaking into your abdomen.

Is a duodenal ulcer life threatening?

A duodenal ulcer isn’t usually life threatening if it’s treated. But an untreated duodenal ulcer that wears away at your intestinal lining can cause a perforation in your duodenum and increase your risk of sepsis, a life threatening immune system response that can affect multiple organs in your body.

Duodenal ulcers often form because of bacterial infections or the overuse of NSAIDs. They can cause burning abdominal pain that can be disruptive to your daily life.

If they’re left untreated, duodenal ulcers can wear away at the mucus lining of your duodenum and lead to perforations or dangerous infections. Contact a doctor if you experience burning stomach pain for a long period of time.