Peptic Ulcer

A peptic ulcer is a sore in the lining of your stomach or in the first part of your small intestine (duodenum). It can cause belly (abdominal) pain and other symptoms. In some cases, a peptic ulcer may get worse. This can lead to serious problems such as bleeding, a hole (perforation), or a blockage (obstruction) in the stomach or duodenum. Treatment is needed to prevent these complications. With treatment, most people fully recover.

Common causes of a peptic ulcer

A peptic ulcer can be caused by:

• Infection from H. pylori (Helicobacter pylori) bacteria

• Long-term use of pain medicines called nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, naproxen, and ibuprofen

• Physical stress, such as burns, head injuries, needing a breathing tube, or being on blood-thinning medicine

• Other rare causes

How a peptic ulcer forms

The lining of your stomach and duodenum is coated with a thick mucus layer. This helps protect the stomach and duodenum from the acids and enzymes they make to help break down the food you eat. When H. pylori is present, it can weaken the mucus layer and irritate the lining underneath. Acid may pass through the weakened mucus layer and cause an ulcer to form. Overuse of NSAIDs can also damage the mucus layer, leading to ulcers.

Symptoms of a peptic ulcer

Peptic ulcers may or may not cause symptoms. If you do have symptoms, they may come and go. They may also range from mild to severe. Common symptoms include:

• Burning feeling, cramping, or hunger-like pain in the stomach area (often 1 to 3 hours after a meal, or in the middle of the night)

• Pain that gets better or worse with eating

• Loss of appetite

• Weight loss

• Nausea or vomiting (vomit may be bloody or look like coffee grounds)

• Black, tarry, or bloody stools (this means the ulcer is bleeding)

Diagnosing a peptic ulcer

Your healthcare provider will ask about your symptoms and health history. You’ll also have a physical exam. In addition, tests will be done to confirm the problem. These tests also help find out if an ulcer is caused by H. pylori. Tests can include:

• Blood, stool, or breath tests. These are done to check for H. pylori and other problems. For blood and stool tests, small samples of your blood and stool are taken. The samples are sent to a lab to be looked at. For a breath test, you'll drink a liquid that contains a harmless compound. H pylori causes the compound to break down and release carbon dioxide gas. By testing the air you breathe out after you drink the liquid, the healthcare provider can tell if the bacteria are present.

• Upper endoscopy. This test is done to see inside the stomach and duodenum. This lets your healthcare provider check for ulcers. During the test, an endoscope (scope) is used. This is a thin, flexible tube with a tiny camera on the end. Once you are given sedation for comfort, the scope is inserted through your mouth. It's then guided down into your stomach or duodenum. If needed, tiny tools may be passed through the scope to take tissue samples (biopsy). Treatment can also be done at the same time if bleeding or other problems are found.

• Upper gastrointestinal (GI) series. This test is done to take X-rays of your upper digestive tract from your mouth to the small intestine. This lets your provider check for ulcers. For this test, you’ll drink a milky liquid that has a substance called barium. The barium coats your upper digestive tract so that it will show up clearly on X-rays.

Treating a peptic ulcer

Medicines are the most common treatment for peptic ulcers. They include:

• Antibiotics. These will treat the H. pylori bacterial infection. In many cases, you’ll need to take at least 2 types of antibiotics.

• Proton pump inhibitors. These block your stomach from making any acid.

• H2 blockers. These reduce the amount of acid your stomach makes.

• Bismuth subsalicylate. This helps protect the lining of your stomach and duodenum from acid.

Take all of the medicines that you’re prescribed exactly as instructed. Don’t stop taking the medicines, even if you're feeling better. The medicines may cause side effects. Your healthcare provider will tell you more about these based on which medicines you're prescribed. During treatment, don't take aspirin and other NSAIDs. You may also be told to stay away from cigarettes, alcohol, and caffeine. These may make your symptoms worse or affect how well your ulcer heals. If your stress level is high, reducing stress may help.

In severe cases, other treatments will likely be done. These may include procedures with an endoscope or surgery. Your provider will tell you more about these treatments, if needed.

When to call your healthcare provider

Call your healthcare provider right away if you have any of these:

• Fever of 100.4°F (38°C) or higher, or as advised by your provider

• Chills

• Frequent vomiting, blood in your vomit, or coffee ground-like substance in your vomit 

• Sudden or severe belly pain

• Dark, tarry, or bloody stools

• Weight loss

• Pain that doesn't get better, even with treatment

Preventing a peptic ulcer

Take the following steps to help prevent a peptic ulcer:

• Reduce your risk for H. pylori infection. Most experts think that H. pylori can be passed through food or water that's contaminated by an infected person. For your safety, the CDC advises following basic hygiene. For instance, always wash your hands with clean, running water and soap after using the bathroom. Wash your hands before making and handling food. Only drink water from safe sources.

• Limit the use of aspirin and NSAIDs. Work with your healthcare provider to change your medicine or to reduce the amount of NSAIDs you take. If you must take aspirin or NSAIDs, ask your provider about other pain medicines you can take to help protect your stomach and duodenum. Sometimes other pain medicines can be used instead. But if you take aspirin because of a heart condition, blood clot, or stroke, talk with your healthcare provider first before you stop taking aspirin.

• Quit smoking. Quit other forms of tobacco, too.

What is a peptic ulcer?

A peptic ulcer is a sore on the lining of your stomach or the first part of your small intestine (duodenum). If the ulcer is in your stomach, it's also called a gastric ulcer. If the ulcer is in your duodenum, it's called a duodenal ulcer. Rarely, they can happen further down your intestine.

Ulcers are fairly common.

What causes peptic ulcers?

In the past, experts thought lifestyle factors, such as stress and diet, caused ulcers. Today, we know that stomach acids and other digestive juices help create ulcers. These fluids burn the linings of your organs.

The most common causes of peptic ulcers include:

• H. pylori bacteria (Helicobacter pylori). Most ulcers are caused by an infection from a bacteria or germ called H. pylori. These bacteria hurt the mucus that protects the lining of your stomach and the first part of your small intestine (the duodenum). Stomach acid then gets through to the lining.
• NSAIDs (nonsteroidal anti-inflammatory medicines). These are over-the-counter pain and fever medicines such as aspirin, ibuprofen, and naproxen. Long-term use can damage the mucus that protects the lining of your stomach.

What are the symptoms of peptic ulcers?

Each person’s symptoms may vary. In some cases, ulcers don’t cause any symptoms.

The most common ulcer symptom is a dull or burning pain in your belly between your breastbone and your belly button (navel). This pain often occurs between meals or may wake you up at night. It can last from a few minutes to a few hours.

Less common ulcer symptoms may include:

• Feeling full after eating a small amount of food
• Burping
• Nausea
• Vomiting
• Not feeling hungry
• Losing weight without trying
• Bloody or black stool
• Vomiting blood

Peptic ulcer symptoms may look like other health problems. Always see your healthcare provider to be sure.

How are peptic ulcers diagnosed?

Your healthcare provider will look at your past health and give you a physical exam. You may also have some tests.

Imaging tests used to diagnose ulcers include:

• Upper GI (gastrointestinal) series or barium swallow. This test looks at the organs of the top part of your digestive system. It checks your food pipe (esophagus), stomach, and the first part of the small intestine (the duodenum). You will swallow a metallic fluid called barium. Barium coats the organs so that they can be seen on an X-ray. 
• Upper endoscopy or EGD (esophagogastroduodenoscopy). This test looks at the lining of your esophagus, stomach, and duodenum. It uses a thin lighted tube called an endoscope. The tube has a camera at one end. The tube is put into your mouth and throat. Then it goes into your esophagus, stomach, and duodenum. Your healthcare provider can see the inside of these organs. A small tissue sample (biopsy) can be taken. This can be checked for H. pylori.

You may also have the following lab tests to see if you have an H. pylori infection:

• Blood tests. These check for infection-fighting cells (antibodies) that mean you have H. pylori. Blood tests can also check for a low blood count if you've had bleeding from the ulcer.
• Stool antigen test. A small sample of your stool is collected and sent to a lab. In 2 or 3 days, the test will show if you have H. pylori.
• Urea breath test. This checks to see how much carbon dioxide is in your breath when you exhale. You will swallow a urea pill that has carbon molecules. If you have H. pylori, the urea will break down and become carbon dioxide. You will have a sample taken of your breath by breathing into a bag. It will be sent to a lab. If your sample shows higher than normal amounts of carbon dioxide, you have H. pylori.

How are peptic ulcers treated?

Treatment will depend on the type of ulcer you have. Your healthcare provider will create a care plan for you based on what is causing your ulcer.

Treatment can include making lifestyle changes and taking medicines. In some cases, you may need surgery.

Lifestyle changes may include:

• Not eating certain foods. Don't eat any foods that make your symptoms worse.
• Quitting smoking. Smoking can keep your ulcer from healing. It's also linked to ulcers coming back after treatment.
• Limiting alcohol and caffeine. They can make your symptoms worse.
• Not using NSAIDs. These include aspirin and ibuprofen. Speak with your provider about whether alternatives are recommended for you.

Medicines to treat ulcers may include:

• Antibiotics.These bacteria-fighting medicines are used to kill the H. pylori bacteria. Often, a mix of antibiotics and other medicines is used to cure the ulcer and get rid of the infection.
• H2-blockers (histamine receptor blockers). These reduce the amount of acid your stomach makes by blocking the hormone histamine. Histamine helps to make acid.
• Proton pump inhibitors or PPIs. These lower stomach acid levels and protect the lining of your stomach and duodenum.
• Mucosal protective medicines. These medicines protect the stomach's mucus lining from acid damage so that it can heal.
• Antacids.These quickly weaken or neutralize stomach acid to ease your symptoms.

In most cases, medicines can heal ulcers quickly. Once the H. pylori bacteria is removed, most ulcers don't come back. You may need to take medicine long term if your ulcer is from another medicine that you must continue to take. The ulcer medicine will help protect your stomach from another ulcer.

In rare cases, you may need surgery if medicines don’t help. You may also need surgery if your ulcer causes other medical problems.

What are possible complications of peptic ulcers?

Ulcers can cause serious problems if you don’t get treatment.

The most common problems include:

• Bleeding.As an ulcer wears away the muscles of the stomach or duodenal wall, blood vessels may become damaged. This causes bleeding.
• Hole (perforation). Sometimes, an ulcer makes a hole in the wall of your stomach or duodenum. When this happens, bacteria and partly digested food can get in. This causes infection and redness or swelling (inflammation).
• Narrowing and blockage (obstruction). Ulcers that are found where the duodenum joins the stomach can cause swelling and scarring. This can narrow or even block the opening to the duodenum. Food can’t leave your stomach and go into your small intestine. This causes vomiting. You can’t eat properly.

When should I call my healthcare provider?

See your healthcare provider right away if you have any of these symptoms:

• Vomiting blood or dark material that looks like coffee grounds
• Extreme weakness or dizziness
• Blood in your stools (your stools may look black or like tar)
• Nausea or vomiting that doesn’t get better, or gets worse
• A sudden, severe pain that may spread to your back
• Losing weight without trying

Untreated peptic ulcers may cause other health problems. Sometimes, they bleed. If they become too deep, they can break through your stomach.

Ulcers can also keep food from going through your stomach.

Key points about peptic ulcers

• These ulcers are sores on the lining of your stomach or the first part of your small intestine (duodenum).
• Stomach acids and other digestive juices help to make ulcers by burning the linings of these organs.
• Most ulcers are caused by infection from a bacteria or germ called H. pylori (Helicobacter pylori) or from long-term use of pain medicines called non-steroidal anti-inflammatory drugs (NSAIDs).
• The most common symptom is a dull or burning pain in the belly between the breastbone and the bellybutton.
• Ulcers may be treated with a combination of lifestyle changes and medicines. In rare cases, surgery is needed.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.
• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your provider tells you.
• At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also, write down any new instructions your provider gives you.
• Know why a new medicine or treatment is prescribed, and how it will help you. Also, know what the side effects are.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if you do not take the medicine or have the test or procedure.
• If you have a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your provider if you have questions.