Information, Symptoms, and Treatment | Specialists in Stomach and Duodenal Ulcers

An ulcer is defined as a deep defect in the mucous membrane. A gastric ulcer affects the stomach, while a duodenal ulcer affects the first section of the intestinal lumen following the stomach. Both types are also collectively referred to as gastric or duodenal ulcers. A characteristic feature is that symptoms tend to occur when the stomach is empty, whereas with a gastric ulcer, pain often occurs after eating. In rare cases, ulcers may heal without treatment; however, in most cases, targeted treatment of gastric and duodenal ulcers is necessary.

Illustration of the gastrointestinal tract, including the duodenum © FGWDesign | AdobeStock

The main cause is infection with Helicobacter pylori, which can trigger both duodenal ulcers and gastric ulcers. This bacterium weakens the stomach lining and increases acid production in the stomach. Infection with the bacterium Helicobacter pylori leads to chronic inflammation, which promotes the development of a duodenal ulcer.

Other causes:

• Use of pain relievers, especially anti-inflammatory drugs such as diclofenac or ibuprofen
• Ulcers caused by pain relievers occur particularly frequently when cortisone is taken at the same time
• Genetic factors (e.g., blood type 0)
• Smoking and stress
• Rare conditions such as Zollinger-Ellison syndrome (excessive hormone production)

If a duodenal ulcer is suspected, early diagnosis is crucial, as the condition can become life-threatening if left untreated.

Possible locations of duodenal ulcers © Henrie | AdobeStock

Typical symptoms include pain in the upper abdomen—which tends to occur when the stomach is empty—as well as nausea and vomiting, or a feeling of pressure and fullness. Some patients only develop symptoms as a result of complications such as bleeding.

The most common complications include:

• Bleeding (visible as vomiting blood or tarry stools)
• Ulcer rupture (perforation) with acute pain, requiring open surgery or immediate emergency care
• Invasion of neighboring organs (penetration)
• Scarring, which can narrow the passage between the stomach and the duodenum
• These complications require surgery if medical treatment is insufficient.

• A duodenal ulcer can reach a blood vessel and cause bleeding. This results in vomiting blood (hematemesis) or the passage of pitch-black stools (known as “tarry stools” or melena). Sometimes the blood loss is gradual and manifests as anemia.
• If the duodenal ulcer breaks through the muscle layer, this is called a perforation. The patient complains of sudden, severe pain. Immediate surgery is required. An X-ray of the abdomen reveals free air in the abdominal cavity.
• If the duodenal ulcer invades another organ (penetration), such as the pancreas, it causes an inflammatory reaction in the affected organ.

Scarring can obstruct the passage of food (pyloric stenosis). Scarring occurs in approximately 2% of patients with peptic ulcer disease.

The most important diagnostic method is gastroscopy. During this procedure, doctors can examine the stomach and duodenum and take tissue samples. A tissue sample determines whether an infection with Helicobacter pylori is present. In addition, there is a breath test that also reliably detects an infection. If a duodenal ulcer is suspected, the evaluation should be conducted promptly so that treatment can be initiated within 2 to 4 to 8 weeks.

No surgical incisions are necessary for a gastroscopy © bilderzwerg | AdobeStock

Treatment depends on the cause:

• If Helicobacter pylori is detected, treatment involves medication with antibiotics and a proton pump inhibitor such as omeprazole or pantoprazole.
• In the case of an HP-negative ulcer, pain relievers that trigger the condition are discontinued and replaced with stomach-friendly medications.
• In severe cases or when complications arise, open surgery may be necessary.

With the right treatment, ulcers can heal—sometimes even on their own, but usually through consistent medication.

What is a stomach or duodenal ulcer?
Both are forms of gastroduodenal ulcer disease. A stomach ulcer affects the stomach, while a duodenal ulcer affects the section of the intestine that follows it.

What are the typical symptoms?
Primarily pain in the upper abdomen, which tends to occur when the stomach is empty, as well as nausea, vomiting, and a feeling of fullness.

How are they diagnosed and treated?
Through an endoscopy with a tissue biopsy and, if necessary, a breath test. Treatment includes antibiotics and proton pump inhibitors.

Are ulcers life-threatening?
Yes, if left untreated, a duodenal ulcer can become life-threatening—especially if complications such as bleeding or a perforated ulcer occur.

How long does it take to heal?
With treatment, improvement begins within 2 weeks, and the ulcers usually heal completely within 4 to 8 weeks.