A duodenal ulcer is a patch in the duodenum where the gut lining has been eroded by stomach acid. The duodenum is the tube of gut leading out of the stomach, and food and stomach acid pass through it. Most often, the formation of this kind of intestinal ulcer involves a bacterial infection in the cells lining the duodenum. This interferes with the cells' production of mucus, which normally protects the gut lining from acid. For this reason, duodenal ulcer treatment commonly involves the use of antibiotics to clear up the infection, and this is typically combined with medication to lower the amount of acid secreted by the stomach, as this helps the ulcer to heal.
In most cases, duodenal ulcers are caused by bacteria known as Helicobacter pylori, or H. pylori. Some people may be infected by the bacteria without experiencing any problems but, in others, the bacteria interfere with the production of substances called prostaglandins, which are normally formed by cells in the gut lining, and they may also increase the amount of stomach acid produced. Prostaglandins are important in protecting the gut lining against stomach acid because they increase the amount of mucus produced by gut lining cells. They also help improve the blood flow to the lining, and stimulate cells to produce bicarbonate, which neutralizes acid. With these protective mechanisms removed, the duodenal lining is vulnerable to damage by stomach acid, so duodenal ulcer treatment not only needs to clear up infection but also has to lower acid production while the gut recovers.
A duodenal ulcer is an example of what is known as a peptic ulcer, which is any ulcer caused by irritation due to stomach acid. The other main type of peptic ulcer is a stomach ulcer. As well as being caused by infection, occasionally, duodenal ulcers can be caused by taking certain drugs, particularly non-steroidal anti-inflammatory drugs such as aspirin. Duodenal ulcer treatment in this case would normally involve ceasing to take the drug causing the problem, while also taking an acid-lowering medication to allow the gut to heal.
Sometimes drugs cannot be stopped, as they may be treating a serious disease such as rheumatoid arthritis. In this case, an acid-suppressing drug might need to be taken long term. Although an ulcer diet is no longer commonly recommended as part of duodenal ulcer treatment, it may be helpful to reduce alcohol, spicy food and coffee. Giving up smoking is known to be beneficial for ulcer healing.
Normally, symptoms of a duodenal ulcer include pain below the breastbone which goes away on eating, nausea and bloating. Unless ulcer complications occur, there may not be any obvious signs apart from possible tenderness under the breastbone. Complications can include bleeding or even erosion of the ulcer right through the gut wall, which is an emergency. Where serious complications arise, surgery is the recommended duodenal ulcer treatment.