Each and every individual will not experience symptoms from duodenal ulcers; and those who do mostly complain of pain and burning sensation in the abdominal region. The other signs and symptoms are discussed below:

• Nausea accompanied by vomiting
• Weight loss
• Decreased appetite
• Undue fatigue
• Anemia due to bleeding ulcers
• Abdominal bloating and belching

In addition to these, individuals may experience other serious symptoms such as:

• Blood in stools
• Pain in the chest
• Blood in vomiting

• Pain

  All patients experience increase in pain with stress. Symptoms The classic symptom is pain in the epigastric area present two to three hours after a meal. [webhealthcentre.com]

  Abstract Typical symptoms of duodenal ulcers include epigastric pain, nausea, vomiting, chest pain and shortness of breath. [ncbi.nlm.nih.gov]

  Links: gastric ulcer (comparison with a duodenal ulcer) epigastric pain right hypochondrial pain abdominal pain relieved by food burning, boring abdominal pain haematemesis melaena right iliac fossa pain (RIF) [gpnotebook.com]

  […] a tye of peptic ulcer disease that is more common than gastric ulcers. typically in age 25-30 what is duodenal ulcer associated with smoking alcholo NSAIDs H.pylori (85%) cyclical pain develops 1-3h after meal hunger pain and central back pain pain is [quizlet.com]

• Weight Loss

  A 70-year-old woman, 15 years after laparoscopic cholecystectomy, developed weight loss, anemia and gastric outlet obstruction secondary to a chronic duodenal ulcer. Gastroscopy showed a clip in the ulcer bed. [ncbi.nlm.nih.gov]

  Other symptoms include belching, vomiting, weight loss, or poor appetite. About a third of older people have no symptoms. Complications may include bleeding, perforation, and blockage of the stomach. Bleeding occurs in as many as 15% of cases. [youtube.com]

  Signs of scar tissue include vomiting and weight loss. All three complications are serious and may require surgery. [healthline.com]

  Loss of appetite with persistent bloating or fullness after eating also suggests gastric outlet obstruction. Prolonged vomiting may cause weight loss, dehydration, and alkalosis. [msdmanuals.com]

• Burning Pain

  Although ulcers don't always cause symptoms, the most common ulcer symptom is a gnawing or burning pain in the abdomen between the breastbone and the navel. The pain often occurs between meals and in early in the morning. [childrenshospital.org]

  It is a burning, painful, gnawing or aching sensation, with fullness or bloating, even awakening the patient from sleep. It is relieved by intake of food or antacids. [webhealthcentre.com]

  Some people with duodenal ulcers have no symptoms at all, while others may have burning pain, severe nausea, and vomiting. In the case of H pylori -related duodenal ulcer, the infection can be treated successfully with antibiotics. [healthgrades.com]

  The most common ulcer symptom is a dull or burning pain in your belly between your breastbone and your belly button (navel). This pain often occurs around meal times and may wake you up at night. It can last from a few minutes to a few hours. [hopkinsmedicine.org]

  Symptoms The most common symptom is a gnawing or burning pain in the abdomen between the breastbone and the navel. The pain often occurs between meals and in the early hours of the morning. [giforkids.com]

• Fatigue

  Eight months later, he complained of general fatigue and anorexia. Gastrointestinal endoscopy revealed a duodenal ulcer at the third portion close to the superior mesenteric artery. [ncbi.nlm.nih.gov]

  Duodenal ulcers can cause a myriad of unpleasant symptoms, including nausea, upper abdominal pain, weight loss and fatigue. Occasionally, an ulcer perforates, causing a hole that goes all the way through the duodenum. [livestrong.com]

  […] eating (duodenal ulcer) Pain which is aggravated by eating (stomach ulcer) Pain which can last anywhere from a few minutes to hours Pain which can disappear for days or weeks at a time Other symptoms may include belching, bloating, nausea, vomiting, fatigue [familyhealthdiary.co.nz]

  […] include: Nausea and vomiting Poor appetite Weight loss Bloating Burping Symptoms that require immediate medical attention are associated with bleeding and they include: Sudden sharp abdominal pain Blood in the stool or vomit Dark-colored stool or vomit Fatigue [innerbody.com]

• Surgical Procedure

  Roux-en-Y gastric bypass is a common surgical procedure used to treat patients with morbid obesity. [ncbi.nlm.nih.gov]

  If surgical procedures are undertaken, the area is resected and the remainder sutured for gastric ulcers. In duodenal ulcers, the duodenum is bypassed and the stomach joined with the small intestine (gastro-jejunostomy). [webhealthcentre.com]

  Stop taking cinnamon at least seven days before any kind of surgical procedure. Cinnamon might affect the way the blood clots and can cause excessive bleeding during surgery. [livestrong.com]

  In addition, mucosal protective drugs (eg, sucralfate) and acid-reducing surgical procedures may be used. Drug therapy is discussed elsewhere (see Drug Treatment of Gastric Acidity). [msdmanuals.com]

• Vomiting

  Less common symptoms include: Belching Nausea Vomiting Poor appetitie Weight loss Difficulty feeding Blood in the stools or vomit Feeling tired and weak A person of any age can get an ulcer. [giforkids.com]

  Abstract Typical symptoms of duodenal ulcers include epigastric pain, nausea, vomiting, chest pain and shortness of breath. [ncbi.nlm.nih.gov]

  Duodenal PTLD Endoscopic photograph of a large mass (M) visualized in a patient with vomiting and abdominal pain who previously had a renal transplant. [naspghan.org]

• Nausea

  Abstract Typical symptoms of duodenal ulcers include epigastric pain, nausea, vomiting, chest pain and shortness of breath. [ncbi.nlm.nih.gov]

  Sometimes there are no signs or symptoms of stomach cancer or duodenal or gastric ulcers, and when they do occur, they may include nausea and loss of appetite with no clear cause. [emedicinehealth.com]

  Less common ulcer symptoms include: belching nausea vomiting poor appetite loss of weight feeling tired and weak [childrenshospital.org]

  Less common symptoms include: belching a bloated feeling nausea, vomiting loss of appetite With a duodenal ulcer, nausea, vomiting, or pain that is worsened by eating usually indicate swelling or obstruction of the narrow channel that connects the stomach [health.harvard.edu]

  […] is more common than gastric ulcers. typically in age 25-30 what is duodenal ulcer associated with smoking alcholo NSAIDs H.pylori (85%) cyclical pain develops 1-3h after meal hunger pain and central back pain pain is relieved by eating or anatacids nausea [quizlet.com]

• Abdominal Pain

  Intestinal Lymphangiectasia Endcoscopic photograph of the 3rd portion of the duodenum in a 15 yo who presented with abdominal pain and diarrhea. [naspghan.org]

  Abstract A young man presented with a sudden onset of severe abdominal pain and vomiting. He also had shortness of breath with right-sided pleuritic chest pain. On examination he was found to have a rigid and diffusely tender abdomen. [ncbi.nlm.nih.gov]

  Links: gastric ulcer (comparison with a duodenal ulcer) epigastric pain right hypochondrial pain abdominal pain relieved by food burning, boring abdominal pain haematemesis melaena right iliac fossa pain (RIF) [gpnotebook.com]

• Dyspepsia

  In the last 2 weeks, the patient suffered from abdominal pain and dyspepsia. Oesophagogastroduodenoscopy showed an ulcerative lesion of the duodenum due to traction of the jejunal tube; the end of the jejunal tube was wrapped in a phytobezoar. [ncbi.nlm.nih.gov]

• Epigastric Pain

  Abstract Typical symptoms of duodenal ulcers include epigastric pain, nausea, vomiting, chest pain and shortness of breath. [ncbi.nlm.nih.gov]

  Figure 1 A 48-year-old man who was receiving medical treatment for peptic ulcer disease experienced intense epigastric pain, sudden in onset and without emesis, four hours before admission. [nejm.org]

  Burning epigastric pain or epigastric cramps between meals, that wake the patient at night. Recurrent episodes characteristically last a few days and are often accompanied by nausea and even vomiting. [medicalguidelines.msf.org]

• Ulcer

  Complications of ulcer disease Complications of duodenal ulcers include bleeding, perforation and gastric outlet obstruction. Bleeding Peptic ulcer bleeds occur when the ulcer erodes an artery in the ulcer base. [surgwiki.com]

  Published on Apr 3, 2016 this presentation gives basic idea about Bleeding duodenal ulcer at MS level Bleeding duodenal ulcer 1. Bleeding Duodenal Ulcer Dr B D Soni SIDSS, SDMH 2. [slideshare.net]

  The ulcer penetrates deep into the mucosa. More than 95% occur in the first part of the duodenum. About 60% of ulcers recur within one year and 90% within two years. [webhealthcentre.com]

  A 70-year-old woman, 15 years after laparoscopic cholecystectomy, developed weight loss, anemia and gastric outlet obstruction secondary to a chronic duodenal ulcer. Gastroscopy showed a clip in the ulcer bed. [ncbi.nlm.nih.gov]

• Irritability

  Monitoring will be ongoing for several weeks to ensure that the redness and overall irritation is going down so that cancer can be ruled out. [planetdrugsdirect.com]

  Limit alcohol use: Too much alcohol use can cause stomach and intestinal lining irritation, which can cause erosion, bleeding and inflammation. [md-health.com]

  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. [hhma.org]

  Keeping a food journal is a smart option, too, as you can keep track of which foods do or do not irritate your condition. [belmarrahealth.com]

  It is important to understand that the diet for duodenal ulcer should be such that it causes less irritation to the abdomen. There are certain food which when taken enhances indigestion and abdominal pain. [epainassist.com]

• Confusion

  Great confusion regarding treatment has arisen because of the number and variety of therapeutic methods which are perennially finding their way into medical literature. [jamanetwork.com]

  Side effects are minimal, though they include rash, gynaecomastia, mental confusion and increasing the action of other drugs. Ranitidine, nizatidine and famotidine are effective. Omperazole is a promising drug. [webhealthcentre.com]

  July 24, 2014 With almost identical active ingredient names, these medications can be easy to confuse—but esomeprazole strontium is not a generic equivalent to Nexium. [goodrx.com]

  I am confused! Thanks for your help. [forums.studentdoctor.net]

  I am confused on both statements. Shouldn’t the level be higher in gastric ulcers? And if it’s low in gastric ulcer why is it higher in duodenal ulcer? A. Great question! [pathologystudent.com]

Prompt diagnosis of duodenal ulcers is required to figure out the nature of the condition. A complete medical history is taken and a thorough physical examination conducted. The other diagnostics tests include:

• X-ray of the abdomen, duodenum and esophagus.
• Endoscopy in order to study the interior of the digestive tract.
• Blood tests to detect anemia.
• Stool tests to detect presence of blood in stool.
• Breath and stomach tissue tests that is done to detect the presence of bacterial infection.

Treatment regime is based on the cause of the duodenal ulcers. It is also dependent on the age of the individual and the extent of disease condition. Primary treatment is focused on medications to eliminate the bacterial infection.

In addition, individuals are put on acid suppressing drugs that work by suppressing the acid contents of the stomach. In the United States, the recommended primary treatment of Helicobacter pylori is proton pump inhibitor which also suppresses acid secretions [7]. Patient should be put on bland diet and strictly advised against smoking. They are also advised to stay away from coffee to allow the medications to work.

If the ulcers have aggravated and are diagnosed at later stages then, surgery is often the preferred treatment plan. It is also the method of choice, when the patients do not respond to medications and lifestyle changes. The use of emergency transcatheter arterial embolization techniques has been successfully used in the control of acute duodenal ulcer hemorrhage [8].

With prompt diagnosis and timely medications, duodenal ulcers get better over time. If the cause of ulcers is infection, then antibiotics form the basis of the treatment plan. Prognosis of the disease is usually good if treatment is initiated quickly.

Meta-analysis studies have shown that duodenal ulcers bleeding dramatically lessens with prompt intravenous proton pump inhibitors after a successful endoscopic procedure [5]. However, one must also understand the fact that modification in lifestyle factors and leading an active lifestyle is also necessary to prevent the recurrence of ulcers. Failure to do so can aggravate existing ulcers and slow down the healing process.

Complications

Untreated ulcers can turn life threatening causing the following complications:

• Gastrointestinal bleeding. Bleeding maybe induced by medications like aspirin, ibuprofen and spironolactone [6].
• Perforation due to untreated ulcers. This may further cause peritonitis characterized by inflammation of the cavity and wall of the abdomen.
• Inflammation and scarring of untreated ulcers can cause narrowing of the intestinal opening.

Causes of duodenal ulcer are many; however research has indicated that bacterial infection is the most common factor leading to development of ulcers. Other factors include:

• Infection due to Helicobacter pylori that weakens the mucous membrane making it susceptible to damage by acids and pepsin.
• Tea and coffee: Excessive consumption of these can also make one prone to develop duodenal ulcers. The substance present in these beverages is known to stimulate the production of acidic substances causing destruction of the mucous lining.
• Smoking is yet another causative factor for ulcers. It is also known to worsen existing ulcers and delay the healing process as well.
• Medications such as non–steroidal anti-inflammatory drugs (like ibuprofen) also reduce the stomach’s natural ability to defend itself against the harmful effects of acid and pepsin even in children [1].
• Stress: Both physical and emotional also triggers the development of ulcers.
• Stomach contents: The incapacity of the stomach to protect itself against acid and pepsin also causes ulcers to develop.
• Previous history of duodenal ulcer or gastric ulcer predisposes one for relapse [2].

Duodenal ulcers are a common complaint amongst individuals of all age groups. It has been estimated that in the United States, as high as 25 million suffer from duodenal ulcers at least once in their life time. It has also been calculated that the health costs for treating ulcers that includes hospitalization, work loss and outpatient care costs about $5.65 billion in the United States.

Muslim nations who practice the Ramadan has an increased risk for duodenal ulcer due to the 24 hour daytime fasting practices during these days [3].

When food is consumed it passes down the esophageal canal and reaches the stomach. Once the food reaches the stomach, it produces acids that aids in the digestion process. The acid mixes with the food and reaches the duodenum wherein the organ produces enzymes for absorption of the digested food.

Under normal circumstances, the acid that is produced usually does not disturb the lining of the stomach as it is protected by a mucosal barrier. Also, there is certain amount of balance maintained between this mucosal barrier and the amount of acid produced. But, when this balance is disturbed, the corrosive nature of the stomach acids disrupts the mucosal lining causing ulcers.

In duodenal ulcer, histologic examinations have revealed that the acid-secreting parietal cells have doubled in size and have significantly increased basal acid output [4].

It is always best to prevent ulcers rather than getting it treated in the later stages. The following measures can be taken to prevent ulcers from developing:

• It is best to avoid non-steroidal anti-inflammatory drugs. If one is at risk of developing ulcers then use of such drugs should be discontinued. A test for Helicobacter pylori should be conducted before taking these medications. If the result is positive it is best to discontinue these medications.
• Patients who must take low dose aspirin or non-steroidal anti-inflammatory drugs for other medical conditions may warrant the use proton pump inhibitors to prevent duodenal ulcers and gastro-intestinal bleeding [9].
• Modification of certain lifestyle factors can go a long way in preventing ulcers. These include cessation of smoking, drinking less tea and coffee and avoiding excessively spiced foods. Studies have shown that smoking increases the risk for duodenal ulcer relapse [10].

Ulcers are basically open sores that generally develop on the skin and mucous membrane. Such open sores that develop in the duodenum are termed as duodenal ulcers.

It is a type of peptic ulcer and occurs as result of bacterial infection. Acid suppressing medications along with antibiotics for 4 to 6 weeks is required for treating the condition.

Definition

Ulcers that develop in the duodenum are termed as duodenal ulcers. These are common and about 25 million individuals of United States fall prey to this disease condition. Prompt diagnosis and treatment can correct the condition; however lifelong precautions are necessary to prevent recurrence of it.

Causes

Duodenal ulcers develop as a result of bacterial infection, faulty dietary habits, improper lifestyle habits, smoking and alcohol consumption.

Symptoms

Individuals with duodenal ulcers generally complain of burning sensation and pain in the abdomen. Other symptoms include weight loss, feeling of tiredness, and blood in stools, nausea, vomiting, chest pain and loss of appetite.

Diagnosis

Complete physical examinations with X-rays of the abdomen are usually the diagnostic tools employed for confirming duodenal ulcers. In addition, endoscopy may also have to be carried out for studying the nature of the ulceration.

Treatment

Treatment of duodenal ulcers generally depends on the nature and severity of the condition. In initial stages, the ulcers can be taken care of by modification in lifestyle factors and medications. Antibiotics to treat infection and acid suppressants are given for treating the ulcers. In more severe cases, operative procedures may have to be carried out for treating the ulcers.

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2. Udd M, Miettinen P, Palmu A, Heikkinen M, Janatuinen E, Pasanen P, et al. Analysis of the risk factors and their combinations in acute gastroduodenal ulcer bleeding: a case-control study. Scand J Gastroenterol. Dec 2007; 42(12):1395-403.
3. Bdioui F, Melki W, Ben Mansour W, Loghmari H, Hellara O, Ben Chaabane N, Saffar H. Duodenal ulcer disease and Ramadan .Presse Med. 2012; 41(9 Pt 1):807-12 (ISSN: 0755-4982)
4. Schubert ML, Peura DA. Control of gastric acid secretion in health and disease. Gastroenterology. Jun 2008; 134(7):1842-60. 
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6. Gulmez SE, Lassen AT, Aalykke C, Dall M, Andries A, Andersen BS, et al. Spironolactone use and the risk of upper gastrointestinal bleeding: a population-based case-control study. Br J Clin Pharmacol. Aug 2008; 66(2):294-9.
7. Chey WD, Wong BC. American College of Gastroenterology guideline on the management of Helicobacter pylori infection. Am J Gastroenterol. Aug 2007; 102(8):1808-25
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9. Sugano K, Matsumoto Y, Itabashi T, Abe S, Sakaki N, et al. Lansoprazole for secondary prevention of gastric or duodenal ulcers associated with long-term low-dose aspirin therapy: results of a prospective, multicenter, double-blind, randomized, double-dummy, active-controlled trial. J Gastroenterol. 2011; 46(6):724-35
10. Sonnenberg A, Müller-Lissner SA, Vogel E, Schmid P, Gonvers JJ, Peter P, et al. Predictors of duodenal ulcer healing and relapse. Gastroenterology. Dec 1981; 81(6):1061-7.