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Stomach & Duodenal Ulcer Disease

Picture of a lady experiencing stomach discomfort

How do I know I have Duodenal ulcer (Stomach ulcer)?

Peptic ulcer disease presents with upper abdominal pain or discomfort. It can be diagnosed either endoscopically or, less commonly, radiologically. Duodenal ulcers usually occur in people aged 30 to 50 years and gastric ulcers in people aged 60+ years.

Causes of Duodenal Ulcer (illustration)

What are the cause of Duodenal ulcer?

  • Bacteria in the stomach, Helicobacter pylori ( pylori), is responsible for > 95% of duodenal ulcers and 70-80% of gastric ulcers.
  • The second most important cause of stomach ulcers are painkillers, called NSAIDs (ibuprofen, naproxen, voltaren, arcoxia , etc) and aspirin.
  • Rare causes of peptic ulcers include conditions associated with production of certain hormones, such as gastrinoma (Zollinger-Ellison syndrome).
  • Alcohol and heave caffeine could be associated with stomach ulcers.

What are the symptoms of Duodenal ulcer?

  • The most common symptom is upper abdominal pain or discomfort. Poor appetite, burping, nausea, vomiting may also be present.
  • Alarm features include weight loss, vomiting of blood or black colored stool, anemia, difficulty swallowing, palpable abdominal mass.
  • It is not possible based on history alone to differentiate between gastric and duodenal ulcers, although gastric ulcer patients tend to be older and are more likely to complain of weight loss.
  • The pain is typically situated in the upper abdomen but may occur in the lower chest and be localized to a very small area (pointing sign).
  • The pain tends to occur when the patient is hungry, 1 to 3 hours after meals, to wake the patient in the night, to be relieved by food, antacids, vomiting, and also it has a pattern of comes and goes. Ulcer pain may also radiate to the back.
Picture of a lady experiencing symptoms of Duodenal Ulcer/stomach ulcer

An illustration of Esophagogastroduodenoscopy, a means of detection of the Duodenal Ulcer/stomach ulcer

How is the ulcer detected?

  • Ulcer is detected by gastroscopy. In the past, when endoscopy was not widely available, the diagnosis was made by special X-ray – barium meal.


  • pylori and NSAIDs cause over 90% of peptic ulcers
  • All people >40 years with dyspepsia should be investigated endoscopically to rule out gastric malignancy
  • All patients with alarm features, such as weight loss, vomiting of blood or black colored stool, anaemia, difficulty swallowing, palpable abdominal mass should go for endoscopy.
  • Always enquire into the complications of ulcer such as bleeding (weakness and melaena) and vomiting (pyloric obstruction). These are emergencies which need urgent admission to the hospital.
  • Surgery is rarely necessary and only if complications such as recurrent severe bleeding, perforation or obstruction develop.

How is the ulcer treated?

  • Medication to heal the ulcers are given after ulcer diagnosis is made. If there bacteria Helicobacter pylori is present, the eradication treatment with combination of antibiotics and ulcer healing medication (PPI) is given.
  • It is important to avoid precipitating factors – such as long-term use of painkillers, heavy alcohol intake, smoking and heavy caffeine intake
A picture of many different type of medication pills

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