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
Differential Diagnosis & Pitfalls
- Gastric ulcer
- Gastroesophageal reflux disease
- Acute coronary syndrome
- Coronary artery disease
- Esophageal spasm
- Mesenteric ischemia
- Crohn disease
- Malignancy (particularly esophageal, gastric, small bowel, and pancreatic)
- Biliary colic
- Zollinger-Ellison syndrome
- Celiac disease
- Tropical sprue
- Chronic pancreatitis
Drug Reaction Data