Peptic Ulcer

Overview

A peptic ulcer is an open sore that forms where the protective lining of the digestive tract is eroded by stomach acid and digestive juices. When the ulcer is in the stomach it is called a gastric ulcer, and when it is in the first part of the small intestine (the duodenum) it is called a duodenal ulcer. Together these are known as peptic ulcer disease.

For many years ulcers were blamed on stress and spicy food, but most are now known to result from infection with a bacterium called Helicobacter pylori (H. pylori) or from the regular use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen, and aspirin. With accurate diagnosis and treatment, the large majority of peptic ulcers heal completely.

Symptoms

The most common symptom is a burning or gnawing pain in the upper abdomen, often between meals or during the night when the stomach is empty. Some people have no symptoms at all until a complication develops.

• Burning stomach pain that may ease with eating or antacids
• Feeling of fullness, bloating, or belching
• Nausea or, less often, vomiting
• Loss of appetite and unintended weight loss
• Intolerance to fatty foods

Warning signs of a serious complication include vomiting blood (which may look like coffee grounds), black or tarry stools, and sudden, severe, unrelenting abdominal pain. These require emergency care.

Causes

Peptic ulcers develop when the balance between stomach acid and the lining's natural defenses breaks down. The two leading causes are:

• H. pylori infection: A common bacterium that weakens the protective mucous coating of the stomach and duodenum, allowing acid to damage the tissue.
• NSAID painkillers: Regular or high-dose use of ibuprofen, naproxen, aspirin, and similar drugs reduces the lining's ability to protect itself.

Less commonly, ulcers are caused by rare acid-producing tumors (Zollinger-Ellison syndrome) or other medications. Smoking, heavy alcohol use, and physical stress from serious illness can make ulcers more likely or slower to heal, though they are not primary causes on their own.

Risk Factors

• H. pylori infection
• Frequent or long-term use of NSAIDs, especially with corticosteroids or blood thinners
• Smoking
• Heavy alcohol consumption
• Older age
• A history of peptic ulcers

Diagnosis

Doctors diagnose peptic ulcers based on symptoms and one or more tests:

• H. pylori testing: Breath, stool, or blood tests to detect the bacterium.
• Upper endoscopy: A thin camera passed through the mouth to view the stomach and duodenum directly and take biopsies if needed.
• Barium swallow (upper GI series): X-rays taken after drinking a contrast liquid, used less often than endoscopy.

Treatment

Treatment focuses on healing the ulcer and removing the underlying cause so it does not return.

• Acid-reducing medication: Proton pump inhibitors (PPIs) such as omeprazole are first-line and allow the lining to heal; H2 blockers are an alternative.
• Antibiotics: If H. pylori is present, a combination of antibiotics with a PPI clears the infection.
• Stopping NSAIDs: Where possible, the offending painkiller is stopped or replaced and a stomach-protecting medicine is added if it must be continued.
• Protective agents: Medicines such as sucralfate coat and shield the ulcer while it heals.

Most ulcers heal within a few weeks to a couple of months. Surgery is rarely needed and is reserved for complications such as bleeding or perforation that cannot be controlled otherwise.

Prevention

• Use NSAIDs only when needed, at the lowest effective dose, and with food or a protective medicine if used long-term
• Ask about acid-reducing medication if you must take NSAIDs regularly
• Get tested and treated for H. pylori if you have a history of ulcers
• Avoid smoking
• Limit alcohol

When to See a Doctor

See a doctor if you have persistent burning stomach pain, especially if it wakes you at night or keeps returning. Seek emergency care immediately for:

• Vomiting blood or material that looks like coffee grounds
• Black, tarry, or bloody stools
• Sudden, sharp, severe abdominal pain
• Feeling faint, dizzy, or short of breath, which can signal internal bleeding

Related Topics

Frequently Asked Questions

References

1. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Peptic Ulcers (Stomach Ulcers).
2. Mayo Clinic. Peptic ulcer — Symptoms and causes.
3. World Gastroenterology Organisation. Helicobacter pylori in developing countries.
4. MedlinePlus, U.S. National Library of Medicine. Peptic ulcer.