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Pain in the middle of the upper stomach
Gastric discomfort
Heartburn
Localized abdominal pain
Abdominal discomfort
Black poop
There is a feeling that the stomach is burning
Not seeing your symptoms? No worries!
Ulcers are sores that can develop in the stomach and small intestines. In severe cases, the ulcers can be deep and cause bleeding within the gut wall. Common causes include the bacteria H. pylori, and painkillers such as Diclofenac, Ibuprofen, Naproxen, Advil, Aleve (NSAIDs).
Your doctor may ask these questions to check for this disease:
The doctor may prescribe drugs to reduce gastric acid levels, and/or antibiotics to kill the H. pylori bacteria, if present. In severe cases, a endoscope (flexible tube with a camera and light at the end) may be need to be inserted through the mouth to stop an ulcer from bleeding.
Reviewed By:
Samantha Nazareth, MD (Gastroenterology)
Board-certified gastroenterologist. Experience managing gastrointestinal conditions (GERD, IBS, ulcerative colitis, Crohn’s, celiac disease, NASH) within healthcare organizations (three ambulatory surgical centers, single-specialty practice, multi-specialty practice and solo practice).
Aiko Yoshioka, MD (Gastroenterology)
Dr. Yoshioka graduated from the Niigata University School of Medicine. He worked as a gastroenterologist at Saiseikai Niigata Hospital and Niigata University Medical & Dental Hospital before serving as the Deputy Chief of Gastroenterology at Tsubame Rosai Hospital and Nagaoka Red Cross Hospital. Dr. Yoshioka joined Saitama Saiseikai Kawaguchi General Hospital as Chief of Gastroenterology in April 2018.
Content updated on Dec 5, 2025
Following the Medical Content Editorial Policy
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Q.
Upper Gut Pain? Why Your Duodenum Is Inflamed and Your Medical Next Steps
A.
Upper middle abdominal burning or gnawing pain that changes with meals is often duodenitis, inflammation of the first part of the small intestine, most commonly from H. pylori infection or frequent NSAID use, with contributors like excess acid, smoking, alcohol, and severe illness. Next steps include reviewing and limiting NSAIDs, testing and treating for H. pylori, using acid suppressants, and seeing a clinician, with urgent care for black or tarry stools, vomiting blood, sudden severe pain, or fainting; there are several factors to consider, and important details that could change your plan are outlined below.
References:
* Shah N, Dhaliwal A, Bulsara M. Duodenitis: an underdiagnosed and undertreated cause of dyspepsia? J Gastroenterol Hepatol. 2017 Jul;32(7):1314-1319. doi: 10.1111/jgh.13735. PMID: 27995642.
* Hooi JKY, Lai WY, Ng WK, Suen MMY, Underwood JFE, Tanyingoh D, Chen G, Xie C, Choo V, Lee ZQ, Ng KY, Bunjamin P, Madsen L, de Sa E, Hilmarsen HT, Qureshi F, Salgado R, Rojas-Sauco E, Duggan S, Daneshmand M, Murray L, Ho P, Hartland CD, Kong S, Kuipers EJ, Lambert JR, Goh KL, Moran AP, Hsu PI, Sung JJY, Zeijlemaker W. Helicobacter pylori Infection and Gastroduodenal Diseases. Nat Rev Gastroenterol Hepatol. 2017 Jan;14(1):3-17. doi: 10.1038/nrgastro.2016.138. PMID: 27558067.
* Caio I, Zlatarich V, Furlan N, De Leo R, D'Amico S, Di Marco R, Corazza GR, Zoli A. Celiac Disease. J Clin Med. 2023 Jul 13;12(14):4687. doi: 10.3390/jcm12144687. PMID: 37510705.
* Valdovinos H, Higuera-de-la-Tijera F, Pérez-Torres E, Herrera-Gómez A, Ramírez-Muñoz MP, Soto-Escalante AA, Ramos-Gómez M, Ramos-Gómez J, Villanueva-Herrera K. Endoscopic Biopsy of the Duodenum: An Update for the Clinician. World J Gastroenterol. 2023 Mar 14;29(10):1551-1563. doi: 10.3748/wjg.v29.i10.1551. PMID: 36923481.
* Tack J, Camilleri M. Diagnosis and Management of Dyspepsia. N Engl J Med. 2023 Apr 6;388(14):1314-1323. doi: 10.1056/NEJMcp2204689. PMID: 37018320.
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Link to full study:
https://www.medrxiv.org/content/10.1101/2024.08.29.24312810v1Bommelaer G, Stef A. Ulcère gastroduodénal: avant et après Helicobacter pylori [Gastroduodenal ulcer before and after Helicobacter pylori]. Gastroenterol Clin Biol. 2009 Aug-Sep;33(8-9):626-34. French. doi: 10.1016/j.gcb.2009.07.004. Epub 2009 Aug 13. PMID: 19682812.
https://www.sciencedirect.com/science/article/abs/pii/S0399832009002449?via%3DihubSovtsov SA. [Management of perforative gastroduodenal ulcer]. Khirurgiia (Mosk). 2015;(11):41-45. Russian. doi: 10.17116/hirurgia20151141-45. PMID: 26978622.
https://www.mediasphera.ru/issues/khirurgiya-zhurnal-im-n-i-pirogova/2015/11/downloads/ru/440023-12072015115Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/peptic-ulcer/symptoms-causes/syc-20354223