Duodenal ulcer

Overview

A duodenal ulcer is a sore or break in the lining of the first part of the small intestine, called the duodenum. It happens when the protective layer of the gut is damaged, often by stomach acid or infection. These ulcers can cause pain, especially when the stomach is empty.

Yes, duodenal ulcers are fairly common. About 1 in 10 people will develop a peptic ulcer at some point in their life.

Duodenal ulcers can affect people of any age, but they are most common in adults aged 30 to 60. Smoking, heavy alcohol use, and certain painkillers increase the risk.

Symptoms

Common symptoms

• A burning or gnawing pain in the upper belly (between the navel and breastbone)
• Pain that gets worse when your stomach is empty (often at night or between meals)
• Pain that improves after eating or taking antacids
• Bloating, burping, or feeling uncomfortably full after meals
• Heartburn or acid reflux

Symptoms in children

• Children may have different symptoms, such as vague belly pain that comes and goes, poor appetite, or weight loss. Some children might not show clear pain, only general irritability or fussiness.

Symptoms in older adults

• Older adults may have less typical symptoms, like no pain at all. Instead, they might experience feeling tired (from anemia due to slow bleeding), black stools (from digested blood), or vomiting blood. These signs need urgent medical attention.

Causes

Main causes

• Infection with a type of bacteria called Helicobacter pylori (H. pylori) – this is the most common cause
• Long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or aspirin, especially at high doses or without a protecting medication

Risk factors

• Smoking tobacco
• Drinking alcohol heavily
• Having a family history of peptic ulcers
• Being of older age
• Having a condition that causes excess stomach acid (rare)
• Psychological stress (may worsen symptoms but is not a direct cause)

When to see a doctor

See a doctor urgently if:

• You vomit blood or have black/tarry stools – go to the emergency room or call your local emergency number immediately.
• You have severe, sudden abdominal pain that does not go away.

Book a routine appointment if:

• You have had belly pain for more than a few days, especially if it wakes you at night or relieves with eating.
• You are taking NSAIDs regularly and develop new stomach problems.
• You have lost weight without trying.
• You feel very tired or look pale.

Diagnosis

A doctor will start by asking about your symptoms, medical history, and medicines. They may press on your belly to check for tenderness. If an ulcer is suspected, they will recommend tests to confirm it and find the cause.

Tests that may be done

• A breath test or stool test to check for H. pylori infection
• An endoscopy (a thin, flexible tube with a camera passed through your mouth into your stomach and duodenum) to see the ulcer directly and take a small tissue sample (biopsy)
• A barium swallow X-ray (less common now) – you drink a chalky liquid that coats the digestive tract, then X-rays are taken

What to expect at your appointment

If an endoscopy is needed, you will be given a mild sedative to help you relax. The test usually takes about 15–30 minutes and is not painful. You may have a mild sore throat afterward. Your doctor will explain the results and what they mean for your care.

Treatment

Treatment for duodenal ulcers aims to heal the sore, relieve symptoms, and prevent it from coming back. The approach depends on the cause – H. pylori infection or NSAID use. Most people get better with medication and lifestyle changes.

Self-care at home

• Avoid or limit alcohol and stop smoking, as both can slow healing and increase ulcer risk.
• Avoid NSAIDs (like ibuprofen, naproxen, aspirin) unless prescribed by a doctor – ask about safer alternatives.
• Eat smaller, more frequent meals to avoid an empty stomach for long periods.
• Manage stress with relaxation techniques, exercise, or talking to someone.
• Get enough sleep and drink plenty of water.

Medical treatments

Doctors can prescribe medicines that reduce stomach acid, protect the stomach lining, or kill H. pylori bacteria. Antibiotics are usually given for H. pylori infection, often as a combination of two antibiotics and an acid reducer. The exact medications and doses are chosen by your doctor based on your health and local guidelines. Treatment typically lasts for 2 weeks for the infection, plus continued acid-reducing medicine for several weeks to allow the ulcer to heal.

When is surgery considered?

Surgery for duodenal ulcers is now rare, thanks to effective medications. It may be needed only if the ulcer causes a severe complication, such as a perforation (a hole in the gut), major bleeding that cannot be controlled by endoscopy, or a blockage that prevents food from passing through the stomach.

Living with this condition

Most people with a duodenal ulcer can lead a normal life after treatment. Follow your doctor’s advice and take all prescribed medications. It may take several weeks to fully heal. Keep a record of your symptoms to share with your healthcare team.

Lifestyle tips

• Stop smoking – get support if needed.
• Limit alcohol to within recommended guidelines (or stop if it triggers symptoms).
• Avoid NSAIDs – use other pain relievers like paracetamol (acetaminophen) after talking to your doctor.
• Practice good hygiene to prevent H. pylori infection (wash hands after using the bathroom and before eating).

Diet and exercise

You do not need a special diet, but eating regular meals can help. Avoid foods that trigger your symptoms (spicy, fried, or acidic foods). Include plenty of fruits, vegetables, and whole grains. Gentle exercise like walking is fine, but avoid heavy lifting if you have pain.

Mental health and emotional wellbeing

Dealing with chronic pain can be stressful. It is normal to feel anxious or worried. Talk to your doctor if you feel down, as counseling or support groups may help.

Prevention

You can reduce your risk of developing a duodenal ulcer by avoiding smoking, limiting alcohol, and being cautious with NSAIDs. If you have H. pylori infection, completing the full treatment can prevent ulcers from coming back.

Vaccines

There is no vaccine for duodenal ulcers or H. pylori infection.

Screening programmes

Routine screening for ulcers is not recommended for everyone. If you have risk factors (like long-term NSAID use) or a family history of peptic ulcers, talk to your doctor about whether you might benefit from testing.

Complications

If left untreated

• Bleeding from the ulcer (can cause anemia or severe blood loss)
• Perforation (a hole through the wall of the duodenum, which is a medical emergency)
• Narrowing or blockage of the duodenum (delays food leaving the stomach, causing vomiting and weight loss)

Long-term outlook

With proper treatment, most duodenal ulcers heal completely within a few weeks to months. The outlook is very good, especially if the cause is treated (like H. pylori infection). Even if you have had complications, prompt medical care can often treat them successfully. Most people return to their usual activities and have a normal life expectancy.

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