Ulcer in the Upper Intestine (Duodenal Ulcer)

What is an ulcer in the upper intestine?

An ulcer in the upper (small) intestine is a raw place or sore in the lining of the part of the intestine that connects to the stomach. The medical term for this kind of ulcer is duodenal ulcer.

Ulcers in the intestine or stomach are called peptic ulcers.

What is the cause?

The lining of the intestine normally keeps the intestine from being hurt by stomach acid and digestive juices. If this protective layer breaks down, stomach acids can damage the walls of the intestine and cause an ulcer. You may get an ulcer when:

• You have bacteria called Helicobacter pylori (H. pylori). These bacteria are the most common cause of ulcers. When H. pylori bacteria infect the intestine, the infection can weaken the lining of the intestine so stomach acid can reach the intestinal wall and damage it.
• You regularly take nonsteroidal anti-inflammatory drugs (NSAIDS), such as aspirin, ibuprofen, and naproxen. These medicines irritate the lining of the stomach and upper intestine, making it easier for stomach acid to damage the lining.
• Your stomach makes too much acid.

Alcohol, cigarettes, and chewing tobacco don’t seem to cause ulcers. However, alcohol and the nicotine in tobacco can make ulcers worse and keep ulcers from healing. Alcohol can irritate the lining of the stomach and increase stomach acid. Smoking also causes your stomach to make more stomach acid.

Caffeine and stress don’t cause ulcers, but they may worsen the pain of ulcers and delay healing.

People with a family history of duodenal ulcers are more likely to get ulcers. The problem is more common in men than women. Most ulcers happen between ages 40 and 50.

What are the symptoms?

Symptoms may include:

• gnawing or burning abdominal pain, especially in the middle of the upper belly
• pain that gets worse when your stomach is empty (just before meals or a couple of hours after you eat)
• pain that may get better when you eat or take antacids
• pain that wakes you up during the night
• vomiting
• weight loss

Ulcers can get worse if they are not treated. They may cause bleeding. If an ulcer is bleeding, you may have:

• vomit containing bright red blood or digested blood that looks like brown coffee grounds
• black, sticky bowel movements (the “black tar” is digested blood)

It is possible, though unusual, to have an ulcer without any symptoms.

How is it diagnosed?

Your healthcare provider will review your symptoms, ask about your medical history, and examine you. You may have 1 or more of these tests:

• blood tests to look for H. pylori bacteria
• a breathing test to look for H. pylori
• tests of a sample of your bowel movement to check for blood (which might come from a bleeding ulcer)
• blood test for anemia (which can be a sign of internal bleeding)
• an upper GI X-ray (for this test you swallow liquid barium, which lets your healthcare provider see ulcers on an X-ray)
• an upper endoscopy, which uses a long, flexible tube and tiny camera put into your mouth, down your throat, and into your stomach and upper intestine to look for ulcers
• a biopsy, which is the removal of a piece of tissue from the intestine during an endoscopy for lab tests (this is also another way to test for H. pylori bacteria)

How is it treated?

Treatment can easily cure an ulcer and prevent complications. Treatment can also keep you from getting another ulcer. Your healthcare provider may prescribe:

• antibiotics to treat H. pylori
• medicine to lower the acid in your stomach
• medicine that coats and protects the lining in your stomach and intestine from acid

If your provider prescribes antibiotics, you will probably need to take them for 2 weeks. You may take medicine to decrease acid for at least 6 weeks. Sometimes you may need to take medicine for several months to keep from getting another ulcer.

Some medicines, such as antacids, can have side effects after you use them for a while. Follow your healthcare provider's instructions carefully, and report any problems right away.

If you are a woman of child-bearing age and are thinking of getting pregnant or could become pregnant, discuss this with your healthcare provider. Some medicines used to treat ulcers can hurt an unborn baby. You will need to stop these medicines if you want to become pregnant. Tell your provider right away if you get pregnant while being treated for an ulcer.

Ulcers get better with treatment but they can come back. You can help lessen the chance that you will have another ulcer by taking your medicines exactly as they are prescribed.

If you don’t get an ulcer treated, possible complications are:

• hemorrhage (a lot of bleeding)
• perforation (a hole through the wall of the intestine made by an ulcer)
• obstruction (a buildup of scar tissue from the ulcer that blocks passage of food)

If you have any of these complications, you may need surgery.

How can I take care of myself?

• Follow the full treatment prescribed by your healthcare provider. Take your medicines exactly as your healthcare provider told you to. Keep all follow-up appointments.
• Follow the diet prescribed by your healthcare provider. Avoid any food or drink that seems to bother your stomach, such as spicy foods; oranges and other citrus fruits; and tea, coffee, and cola.
• Avoid alcohol, cigarettes, and chewing tobacco because they slow the healing of ulcers.
• Ask your provider if you should avoid drugs that irritate the stomach, such as aspirin, ibuprofen, and naproxen. If your provider says it’s OK to take these drugs, try taking them with food to help avoid irritating your stomach. These drugs may cause stomach bleeding and other problems. These risks increase with age. Read the label and take as directed. Unless recommended by your healthcare provider, do not take these drugs for more than 10 days for any reason. Ask your provider if you can use acetaminophen for pain relief instead.
• Get plenty of rest and sleep.
• Exercise as recommended by your provider.
• Do things to help your mood and emotions. If stress is a problem for you, talk to your provider about your feelings.
• Ask your healthcare provider:
  • how and when you will hear your test results
  • how long it will take to recover from this illness
  • what activities you should avoid and when you can return to your normal activities
  • how to take care of yourself at home and what symptoms or problems you should watch for and what to do if you have them
• Make sure you know when you should come back for a checkup.