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Duodenal ulcer
Other Resources UpToDate PubMed

Duodenal ulcer

Contributors: Michael W. Winter MD, Khaled Bittar MD, Nishant H. Patel MD, Desiree Rivera-Nieves MD
Other Resources UpToDate PubMed


A duodenal ulcer is a form of peptic ulcer disease. It is defined by a mucosal defect extending through the muscularis mucosa in the intestinal lining. Duodenal ulcers are at risk for eroding into blood vessels, leading to gastrointestinal bleeding.

NSAIDs are a common cause of duodenal ulcer. Mucosal injury due to chronic infection from Helicobacter pylori may be a cause. Smoking is a strong risk factor for developing ulcers. There are other much less common causes including Zollinger-Ellison syndrome.

Patients can present with a variety of symptoms from duodenal ulcers. Epigastric abdominal pain and dyspepsia are most common. If eroded into a blood vessel, hematemesis, melena, or rarely bright red blood per rectum (if there is brisk bleeding) can be presenting symptoms.

Helicobacter pylori is a common worldwide infection predisposing to duodenal ulcers. Untreated, it is also a carcinogen associated with the development of gastric cancer.

Patients with concern for a duodenal ulcer, whether bleeding or not bleeding, should undergo an esophagogastroduodenoscopy (EGD) to confirm the diagnosis.


K26.9 – Duodenal ulcer, unspecified as acute or chronic, without hemorrhage or perforation

51868009 – Duodenal ulcer disease

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Gastritis
  • Gastric ulcer
  • Gastroesophageal reflux disease
  • Acute coronary syndrome
  • Coronary artery disease
  • Esophagitis
  • Esophageal motility disorder
  • Gastroparesis
  • Gastroenteritis
  • Acute mesenteric ischemia
  • Crohn disease
  • Malignancy (particularly Esophageal carcinoma, Gastric cancer, small bowel, and Pancreatic carcinoma)
  • Biliary calculus 
  • Zollinger-Ellison syndrome
  • Celiac disease
  • Tropical sprue
  • Chronic pancreatitis

Best Tests

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Management Pearls

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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Last Reviewed:05/23/2017
Last Updated:09/16/2020
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Patient Information for Duodenal ulcer
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Duodenal ulcer
A medical illustration showing key findings of Duodenal ulcer : Nausea, Vomiting, Epigastric pain, Recurring episodes or relapses, Melena, Dyspepsia
Copyright © 2024 VisualDx®. All rights reserved.