What Are Peptic Ulcers? Symptoms, Causes, Diagnosis, Treatment, and Prevention

A peptic ulcer is a type of sore that develops on the inner lining of your stomach or duodenum, the upper part of the small intestine just beyond the stomach. In some cases, a peptic ulcer may develop just above your stomach, in your esophagus, according to the National Institute of Diabetes and Digestive and Kidney Diseases.

Anyone can develop a peptic ulcer, and the most common symptom is abdominal pain, according to the Mayo Clinic. Peptic ulcers may be caused by a bacterial infection, certain drugs, or rare tumors. They are not caused by stress or spicy foods.

Types of Peptic Ulcers

The most common kinds of peptic ulcers are named based on the location where they occur. These include:

Gastric Ulcers A common type of ulcer, these occur on the inside of the stomach.

Duodenal Ulcers These are located in the upper part of the small intestine, called the duodenum.

Esophageal Ulcers These occur inside the esophagus, the tube that carries food from your throat to your stomach.

You can have more than one type of peptic ulcer at the same time.

Many people with peptic ulcers don’t have any signs or symptoms. If they do, however, upper abdominal pain is the most common one.

The abdominal pain can occur anywhere from your navel up to your breastbone, and it may follow any of these patterns:

• Feels worse when your stomach is empty
• Feels better temporarily when you eat or take an antacid
• Gets worse at night
• Comes and goes for days or weeks

Less commonly, a severe or complicated peptic ulcer may cause the following symptoms:

• Nausea or vomiting
• Vomiting red or dark blood
• Bloody, black, or tar-like stools
• Unexplained weight loss
• Changes in your appetite
• Difficulty breathing
• Feeling faint or weak

For a long time, it was thought that spicy foods or stress caused peptic ulcers — but doctors now know that isn’t the case. Those two factors can, however, make peptic ulcer symptoms worse, the Mayo Clinic notes.

In fact, the most common causes of ulcers are:

• Use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, Advil or Motrin (ibuprofen), and Aleve (naproxen), which can damage the inner lining of your digestive tract
• Helicobacter pylori, a type of bacteria that can infect your stomach

Certain factors may put you at greater risk of developing a peptic ulcer, including:

• Taking high doses of NSAIDs
• Taking NSAIDs regularly over a long period of time
• Taking both NSAIDs and corticosteroids, medications that may be prescribed to treat asthma, arthritis, or lupus
• Being female
• Being 70 or older
• Smoking
• Drinking alcohol
• Having a history of peptic ulcers

In very rare cases, peptic ulcers may be caused by a condition called Zollinger-Ellison syndrome (also known as gastrinoma). It occurs when a tumor of acid-producing cells forms in the digestive tract, producing an excessive amount of acid that damages nearby tissue. Other rare causes of peptic ulcers may include serious illness, surgery, or medications other than NSAIDs, according to the Cleveland Clinic.

If your doctor suspects that you may have a peptic ulcer, the next steps include taking a full medical history and performing a physical exam. Your doctor may also order the following diagnostic tests:

• Lab Test A stool test or a breath test may be used to determine whether H. pylori bacteria are present in your body.
• Endoscopy During this procedure, a hollow tube with a camera will be passed down your throat to your esophagus, stomach, and small intestine. It allows your doctor to look for a peptic ulcer and take a biopsy (tissue sample) if one is present.
• Barium Swallow For this test, you’ll swallow a white liquid containing barium, which coats your digestive tract to make ulcers more visible in a series of X-rays of your upper digestive tract.

Peptic ulcers caused by medication usually begin to heal shortly after you stop taking the medication. Doctors often recommend taking antacids for two to six weeks to assist with healing and relieve pain.

Ulcers caused by H. pylori will heal when the bacteria is killed. The typical course of treatment includes two weeks of antibiotics, along with acid-suppressing medicine. This is usually followed by an additional four to eight weeks of acid-suppressing medicine alone.

It’s possible for an ulcer to heal temporarily without antibiotics, but it will likely recur — or another one will form nearby — if the bacteria are not killed.

Duodenal ulcers take roughly six weeks to heal. Gastric ulcers tend to heal more slowly, taking two or three months to heal completely in cases where there are no other complications.

Your course of treatment will be based on the cause of your peptic ulcer. Treatment typically involves taking acid-suppressing medications to kill H. pylori bacteria, if present, and to promote healing, as well as stopping any medications that are causing your peptic ulcer. You may also experience symptom relief from certain lifestyle measures.

Medication Options

If your peptic ulcer is found to be caused by an H. pylori infection, your doctor will prescribe antibiotics to kill the bacteria in your digestive tract.

Over-the-counter antacids like Mylanta, Maalox, or Tums can help you feel better, but they will not heal ulcers. If left untreated, complications from ulcers can occur.

Proton pump inhibitors (PPIs) are drugs that block acid production and promote healing of peptic ulcers.

PPI drugs include:

• Esomeprazole (Nexium)
• Lansoprazole (Prevacid)
• Omeprazole (Prilosec, Zegerid)
• Pantoprazole (Protonix)
• Rabeprazole (Aciphex)

Acid blockers, also called H2 blockers, reduce acid production and heal ulcers. These include:

• Cimetidine (Tagamet)
• Famotidine (Pepcid)
• Nizatidine (Axid)
• Ranitidine (Zantac)

Another option that your doctor may prescribe is a cytoprotective agent — a drug that protects the lining of your stomach and small intestine, which can help relieve symptoms of an ulcer.

Alternative and Complementary Therapies

Certain lifestyle changes may help you recover from a peptic ulcer:

• Watch your diet. If you know that there are specific foods that make your ulcer feel worse, avoid them until your treatment is over. For many people, those include alcohol, caffeine, fatty foods, spicy foods, and chocolate.
• Stop smoking. Ulcers take longer to heal, and medications for ulcer treatment may be less effective, if you are a smoker. Scientists don’t know exactly why smoking has those effects.
• Use pain medications with caution. Pain relievers known as NSAIDs, which include aspirin, ibuprofen, and naproxen, can slow ulcer healing even if they didn’t cause your peptic ulcer. Acetaminophen (Tylenol) does not cause ulcers, so it may be a good substitute. Be sure to talk to your doctor before taking any of these medications; they may continue putting you on a PPI drug to prevent ulcer recurrences.

Prevention of Peptic Ulcers

Limiting your use of NSAIDs may help prevent peptic ulcers. Taking an alternative pain reliever, such as acetaminophen, may help you avoid NSAIDs. If you need to take an NSAID, opt for the lowest effective dose and take it with a meal.

Peptic ulcers caused by an infection with H. pylori are not usually preventable.

Limiting alcohol and avoiding smoking may also help prevent peptic ulcers.

Left untreated, peptic ulcers can result in severe complications and potential medical emergencies:

• Internal Bleeding Ulcers can cause bleeding that occurs quickly or slowly over time. Gradual bleeding can lead to anemia (inadequate red blood cells), while sudden bleeding often requires immediate hospitalization, potentially including a blood transfusion.
• Perforation (Hole) in the Stomach Wall If an ulcer eats through your stomach wall completely, you’ll be at risk of an infection in your abdominal cavity (peritonitis), which may be life-threatening.
• Obstruction Swelling or scarring related to your ulcer can block the passage of food through your digestive tract. If that happens, you may feel full quickly or vomit when you eat, and you may lose weight, according to the Mayo Clinic.

Symptoms of a severe or complicated peptic ulcer may include:

• Blood (black or red) in your stool
• Blood in your vomit, or vomit that looks like coffee grounds
• Increasing pain
• Weakness
• Mental confusion
• Severe abdominal distension (outward swelling)

If you think you or someone you know is having an ulcer emergency, seek immediate medical attention.

Peptic ulcers are quite common, affecting about 4 million people each year in the United States. It is estimated that 1 in 10 people will develop a peptic ulcer at some point, according to the Cleveland Clinic.

Infection with H. pylori is less common in wealthier countries such as the United States, and it typically affects older adults more than younger ones.

A rare cause of peptic ulcers is a condition called Zollinger-Ellison syndrome, which occurs when one or more tumors form in the pancreas or duodenum (upper part of the small intestine). These tumors secrete large amounts of a hormone that causes your stomach to produce too much acid. The excess acid can lead to peptic ulcers and symptoms such as diarrhea, abdominal pain, acid reflux, nausea and vomiting, and decreased appetite, according to the Mayo Clinic.

Treatment for Zollinger-Ellison syndrome may include surgical removal of tumors, chemotherapy, or taking drugs to control excess stomach acid.

Favorite Organizations for Essential Information on Peptic Ulcers

American College of Gastroenterology

This is a professional association of gastroenterologists and other gastrointestinal professionals. Its site offers an abundance of information on peptic ulcers, including information on diagnosis and treatment, as well as a glossary of medical terms associated with the condition.

National Institute of Diabetes and Digestive and Kidney Diseases

This is a great resource for learning more about peptic ulcers. The site also offers advice on diet and nutrition, and it provides a link to search for clinical trials related to the condition.

Additional reporting by Quinn Phillips