Duodenal Ulcers: Duodenal ulcers have various causes including NSAID use, H. Pylori infections, duodenitis, and impaired duodenal bicarbonate secretion when increased acid and peptic activity is present. Increased peptic activity and decreased ability of the duodenum to create a buffer may cause increased risk of mucosal injury and gastric metaplasia. If H. Pylori infection is the contributing cause, the gastric metaplasia can them become inflamed. This inflammation or the infection itself disrupts the process of mucosal defense or regeneration. Impairment of this process can result in ulceration if not treated promptly. Some of the most common symptoms include black or tarry stool, bright red blood in vomit, cramps in the abdomen, dark or bright red blood mixed in with the stool, dizziness or faintness, fatigue, shortness of breath, paleness, “coffee-ground” vomit, and general weakness. Treatment includes antibiotics, H2 blockers, PPIs, antacids, and mucosal protective agents.