Duodenal ulcers are typically caused by increased acid and pepsin secretion, and potentiated by NSAID use and Helicobacter pylori infection. It is important to address other causes of ulcer disease, such as ulcerogenic medication use, Zollinger Ellison syndrome, hyperparathyroidism, other malignancy, and antral G cell hyperplasia if applicable. Initial management of both bleeding and uncomplicated ulcers is nonoperative. Questions will surround complications of ulcers: bleeding, obstruction, perforation, intractability.