A Duodenal Ulcer Was Found at Endoscopy: What Does It Mean?

A duodenal ulcer is a loss of tissue, deeper than a superficial erosion, in the lining of the duodenum — the part of the bowel that begins immediately after the stomach. It is seen most often in the bulb, the first part of the duodenum.

The most important causes of duodenal ulcer are Helicobacter pylori (H. pylori) infection and aspirin/NSAID painkillers.

What causes a duodenal ulcer?

The main causes are:

• H. pylori infection
• Aspirin and NSAID painkillers
• Smoking
• Some medicines and severe systemic illness
• More rarely, conditions causing excessive stomach acid production

Duodenal ulcers due to H. pylori have become less common as the infection has come to be treated.

What symptoms can it cause?

Some patients have no symptoms at all. The most common complaints are:

• Pain or burning in the upper abdomen
• Pain that can appear when hungry or at night
• Indigestion
• Nausea
• Bloating

But a diagnosis of duodenal ulcer cannot be made from the relationship between the pain and meals alone.

Is a duodenal ulcer cancer?

Generally not. The likelihood of a typical duodenal ulcer being malignant is very low.

There is an important difference from gastric ulcer here: whereas biopsy matters more in gastric ulcers in order to rule out malignant disease, routine biopsy of typical-looking duodenal ulcers is mostly not needed.

But unusual, irregular or non-healing lesions, or those where another condition is suspected, are assessed separately.

Should H. pylori be looked for?

Yes, it matters.

H. pylori should be looked for in a patient found to have a duodenal ulcer. If the infection is found, eliminating it with appropriate treatment (eradication) helps the ulcer heal and markedly reduces the risk of it coming back.

Confirming with an appropriate test after treatment that H. pylori really has been eliminated matters.

How is it treated?

Treatment is planned according to the cause of the ulcer. Approaches generally include:

• Acid-suppressing medicines such as proton pump inhibitors (PPIs)
• Eradication treatment if H. pylori is present
• Reviewing the use of aspirin and NSAIDs
• Stopping smoking

How long does it take to heal?

Most uncomplicated duodenal ulcers heal within a few weeks with appropriate treatment.

But the pain going away does not show that H. pylori has been eliminated. If H. pylori treatment has been given, eradication needs confirming separately.

Is a follow-up endoscopy needed?

Not for every duodenal ulcer. In a typical-looking, uncomplicated duodenal ulcer where the patient has been treated appropriately and their symptoms have settled, a routine follow-up gastroscopy is mostly not needed.

By contrast, a follow-up endoscopy may be needed where:

• The ulcer is not healing
• Symptoms are continuing
• The appearance is unusual
• Bleeding or another complication has developed
• There is doubt about the diagnosis

What complications can a duodenal ulcer cause?

• Bleeding The ulcer can involve a blood vessel and lead to gastrointestinal bleeding.
• Perforation The ulcer can go right through the bowel wall and cause a hole.
• Narrowing Repeated ulceration and healing can lead to narrowing of the duodenum and difficulty emptying the stomach.

When is urgent assessment needed?

Remember

• H. pylori Is one of the important causes of duodenal ulcer.
• Aspirin and NSAIDs Can increase the risk of ulcer and bleeding.
• A duodenal ulcer Is typically not cancer.
• In a typical duodenal ulcer Unlike gastric ulcer, routine biopsy is mostly not needed.
• A follow-up endoscopy Is not needed in every patient.
• Bleeding and perforation Are important complications.