What is a duodenal ulcer?

A duodenal ulcer is a sore that forms in the lining of the duodenum. Your duodenum is the first part of your small intestine, just beyond the stomach. These ulcers often cause pain in the upper abdomen (tummy area), just below the breastbone.

You can also get an ulcer in your stomach. Stomach ulcers and duodenal ulcers are 2 types of peptic ulcers. If you have either of these, you have what's called 'peptic ulcer disease'. Once treated, they usually get better within a few weeks to months.

What are the symptoms of a duodenal ulcer?

If you have a duodenal ulcer, you might:

• have pain in your abdomen (stomach or tummy area)
• feel full and bloated after eating
• feel like you might vomit
• lose weight
• have heartburn
• feel discomfort when swallowing or eating

Your stomach pain may come and go. It can often be relieved by eating food or taking an antacid medicine. Sometimes food makes the pain worse. This can happen immediately or soon after eating.

If an ulcer causes complications, you may experience:

• sudden, severe pain in your stomach that doesn't go away
• vomit or stools (poo) that look bloody or a black colour

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What causes duodenal ulcers?

A duodenal ulcer is usually caused by a type of bacteria called Helicobacter pylori, or H. pylori.

The bacteria can weaken the protective lining of your duodenum. If the protective lining is damaged, an ulcer can form.

Some medicines can also cause duodenal ulcers, particularly anti-inflammatory medicines such as ibuprofen and aspirin — these are also known as NSAIDs. They can sometimes harm the protective lining, allowing acid to create an ulcer.

If you are undergoing treatment for cancer, you are at a higher risk of developing a duodenal ulcer.

There are some lifestyle factors that may make you more likely to have a duodenal ulcer, such as:

• smoking
• drinking a lot of alcohol
• health conditions such as Crohn's disease or cystic fibrosis
• experiencing stress

When should I see my doctor?

See your doctor if you:

• experience abdominal pain
• feel nauseous
• lose weight without trying to

Go to the emergency department if:

• you have sudden severe pain in your stomach that doesn't go away
• your vomit or stools (poo) look bloody or a black colour

If you have severe pain in your abdomen that doesn't go away, or if you have blood in your vomit, go to your nearest hospital emergency department immediately or call triple zero (000) and ask for an ambulance.

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How are duodenal ulcers diagnosed?

To diagnose a duodenal ulcer, your doctor will talk to you and examine you. They will probably arrange a test to find out if you have H. pylori in your body. These tests may include:

• a blood test
• a stool (poo) sample
• a breath test

Your doctor may also arrange for you to have a gastroscopy. This is also called an endoscopy. During an endoscopy a specialist doctor uses a thin, flexible tube with a camera on the end to look inside your stomach and duodenum. This way they can see any ulcers or changes.

If you have a gastroscopy, your surgeon might take a sample of tissue, called a biopsy, to test for H. pylori.

How are duodenal ulcers treated?

If your ulcer is caused by H. pylori, the usual treatment is 'triple therapy'. This means taking 2 antibiotics and a proton pump inhibitor (PPI) medicine. The antibiotics kill the bacteria, while the PPI medicine reduces the acid made by your stomach.

If you don't have H. pylori infection and you have been using anti-inflammatory medicines, you will be advised to stop taking them if possible. You will also need to start taking a PPI medicine to reduce acid production in your stomach.

You can make some other changes to improve your symptoms, such as:

• quitting smoking
• drinking less alcohol
• losing weight if you are living with obesity
• eating smaller meals
• trying to manage your stress
• having your evening meal a few hours before bedtime
• avoiding coffee, fatty foods, spicy foods and acidic foods such as tomato

What are the complications of duodenal ulcers?

If left untreated, your duodenal ulcer may get worse. This can cause complications, such as:

• bleeding — this can vary from a small amount to a serious, life-threatening bleed
• perforation — this is when the ulcer goes all the way through the wall of the duodenum, causing food and acid to leak into your abdomen

These complications can cause sharp pain, bloody vomit or bloody stools (poo) and require emergency treatment.

Can duodenal ulcers be prevented?

There are lifestyle changes that you can make to avoid duodenal ulcers. These include:

• taking NSAIDs with food, if you need to take them
• stopping smoking
• eating a healthy and well-balanced diet

If you have H. pylori infection, taking antibiotics to treat the infection can reduce your risk of getting an ulcer. Practicing good hygiene can help prevent infection.

Resources and support

Visit the Gastroenterological Society of Australia for information about Helicobacter pylori and endoscopies.

Read the Royal Children's Hospital fact sheet on H. pylori.

The Emergency Care Institute peptic ulcer disease factsheet has tips on care at home if you have a duodenal ulcer.

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with you 24 hours a day, 7 days a week.