What is a peptic ulcer?
A peptic ulcer is a sore in the lining of your stomach or duodenum *. The duodenum is the first part of your small intestine. A peptic ulcer in the stomach is called a gastric ulcer. One that is in the duodenum is called a duodenal ulcer. A peptic ulcer also may develop just above your stomach in the esophagus, the tube that connects the mouth to the stomach. But most peptic ulcers develop in the stomach or duodenum.
Drawing of the digestive system with the stomach and duodenum highlighted and labeled (see above). The esophagus, gallbladder, liver, large intestine, pancreas, small intestine, rectum, and anus are also labeled. An enlarged cross-section drawing shows an ulcer in the duodenum.
Peptic ulcers occur in the lining of your stomach, duodenum, or esophagus.
Many people have peptic ulcers. You can have both gastric and duodenal ulcers at the same time and you also can have more than one ulcer in your lifetime.
Peptic ulcers can be treated successfully. Seeing your doctor is the first step.
What causes peptic ulcers?
Most peptic ulcers are caused by Helicobacter pylori (H. pylori), a germ that causes infection Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and Ibuprofen H. pylori is the most common cause of peptic ulcers. Doctors think H. pylori may be spread through unclean food or water or by mouth-to-mouth contact, such as kissing. Even though many people have an H. pylori infection, most of them never develop an ulcer.
Use of NSAIDs is the second most common cause of peptic ulcers. But not everyone who takes NSAIDs gets a peptic ulcer. Ulcers caused by NSAIDs are more often found in people who are age 60 or older are female have taken NSAIDs for a long time have had an ulcer before
Other causes of peptic ulcers are rare. One rare cause is Zollinger-Ellison syndrome—a disease that makes the body produce too much stomach acid, which harms the lining of the stomach or duodenum.
Stress or spicy food does not cause peptic ulcers, but either can make ulcer symptoms worse.
What are the symptoms of peptic ulcers?
A dull or burning pain in your stomach is the most common symptom of peptic ulcers. You may feel the pain anywhere between your belly button and breastbone. The pain often starts between meals or during the night
- briefly stops if you eat or take antacids
- lasts for minutes to hours
- comes and goes for several days or weeks
Other symptoms of peptic ulcers may include
- weight loss
- poor appetite
- feeling sick to your stomach
A dull or burning pain in your stomach is the most common symptom of peptic ulcers.
Even if your symptoms are mild, you may have peptic ulcers. You should see your doctor to talk about your symptoms. Peptic ulcers can get worse if they aren’t treated.
Call your doctor right away if you have
- sudden sharp stomach pain that doesn’t go away
- black or bloody stools
- bloody vomit or vomit that looks like coffee grounds
Call your doctor if the pain gets worse.
These symptoms could be signs an ulcer has
- broken a blood vessel
- gone through, or perforated, your stomach or duodenal wall
- stopped food from moving from your stomach into the duodenum
These symptoms must be treated quickly. You may need surgery.
How are peptic ulcers diagnosed?
Tell your doctor about your symptoms and which medicines you take. Be sure to mention those you get without a prescription,
To see if you have an H. pylori infection, your doctor will test your blood, breath, or stool. About half of all people who develop an ulcer from NSAIDs also have an H. pylori infection.
Your doctor also may want to look inside your stomach and duodenum by doing an endoscopy or an upper gastrointestinal (GI) series—a type of x ray. Both procedures are painless.
Peptic ulcers can show up on x rays.
For an endoscopy, you will be given medicine to relax you. Then the doctor will pass an endoscope—a thin, lighted tube with a tiny camera—through your mouth to your stomach and duodenum. Your doctor also may take a small piece of tissue—no bigger than a match head—to look at through a microscope. This process is called a biopsy.
For an upper GI series, you will drink a liquid called barium. The barium will make your stomach and duodenum show up clearly on the x rays.
How are peptic ulcers treated?
If you have peptic ulcers, they can be cured. Depending on what caused your ulcers, your doctor may prescribe one or more of the following medicines:
- a proton pump inhibitor (PPI) or histamine receptor blocker (H2 blocker) to reduce stomach acid and protect the lining of your stomach and duodenum
- one or more antibiotics to kill an H. pylori infection
- a medicine that contains bismuth subsalicylate, such as Pepto-Bismol, to coat the ulcers and protect them from stomach acid
These medicines will stop the pain and help heal the ulcers.
If an NSAID caused your peptic ulcers, your doctor may tell you to
- stop taking the NSAID
- reduce how much of the NSAID you take
- take a PPI or H2 blocker with the NSAID
- switch to another medicine that won’t cause ulcers
You should take
- only the medicines your doctor tells you to take
- all medicines exactly as your doctor tells you to, even if your pain stops
Tell your doctor if the medicines make you feel sick or dizzy or cause diarrhea or headaches. Your doctor can change your medicines.
And if you smoke, quit. You also should avoid alcohol. Smoking and drinking alcohol slow the healing of ulcers and can make them worse.
Can antacids or milk help peptic ulcers heal?
Neither antacids—such as Tums—nor milk can heal peptic ulcers, although each may make you feel better briefly. Check with your doctor before taking antacids or drinking milk while your ulcers are healing.
Some of the antibiotics used for H. pylori infection may not work as well if you take antacids. And while antacids may make ulcer pain go away for a while, they won’t kill the H. pylori germ. Only antibiotics can do that.
Many people used to think that drinking milk helped peptic ulcers heal. But doctors know now that while milk may make ulcers feel better briefly, it also increases stomach acid. Too much stomach acid makes ulcers worse.
Check with your doctor before taking antacids while your ulcers are healing.
What if peptic ulcers don’t heal?
In many cases, medicines heal ulcers. If an H. pylori infection caused your ulcers, you must finish all antibiotics and take any other medicines your doctor prescribes. The infection and ulcers will only heal if you take all medicines as prescribed.
When you have finished your medicines, your doctor will do a breath or stool test to be sure the H. pylori infection is gone. Sometimes, the H. pylori germ is still there, even after a person has taken all the medicines correctly. If that happens, your doctor will prescribe different antibiotics to get rid of the infection and cure your ulcers.
Rarely, surgery is needed to help ulcers heal. You may need surgery if your ulcers
- don’t heal
- keep coming back
- perforate the stomach or duodenal wall
- block food from moving out of the stomach
- remove the ulcers
- reduce the amount of acid in your stomach
Can peptic ulcers come back?
Yes. If you smoke or take NSAIDs, your ulcers may come back. If you need to take an NSAID, your doctor may switch you to a different medicine or add medicines to help prevent ulcers.
What can I do to prevent peptic ulcers?
To help prevent ulcers caused by H. pylori,
- wash your hands with soap and water after using the bathroom and before eating
- eat food that has been washed well and cooked properly
- drink water from a clean, safe source
To help prevent ulcers caused by NSAIDs,
- stop using NSAIDs, if possible
- take NSAIDs with a meal, if you still need NSAIDs
- use a lower dose of NSAIDs
- ask your doctor about medicines to protect your stomach and duodenum while taking NSAIDs
- ask your doctor about switching to a medicine that won’t cause ulcers
Points to Remember
- A peptic ulcer is a sore in the lining of the stomach, duodenum, or esophagus.
- Helicobacter pylori (H. pylori), a germ, is the most common cause of peptic ulcers.
- Use of nonsteroidal anti-inflammatory drugs (NSAIDs)—such as aspirin and ibuprofen—is the second most common cause of peptic ulcers.
- Neither stress nor spicy food causes peptic ulcers. But like smoking or drinking alcohol, either can make ulcer symptoms worse.
- If H. pylori caused the ulcers, antibiotics are taken to kill the germ.
- If NSAIDs caused the ulcers, a doctor will decide the best treatment.
- Medicines that reduce stomach acid and protect the lining of the stomach and duodenum help ulcers heal.
Tips to help prevent ulcers caused by H. pylori infection include
- washing your hands after using the bathroom and before eating
- eating properly prepared food
- drinking water from a clean, safe source
Tips to help prevent ulcers caused by NSAIDs include
- stopping NSAIDs, if possible
- taking NSAIDs with a meal
- using a lower dose of NSAIDs
- talking with your doctor about medicines to protect your stomach and duodenum
- while taking NSAIDs asking your doctor about switching to a medicine that won’t cause ulcers