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

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

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

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.

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.

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

The Takeaway

• Peptic ulcers are sores that develop on the inner lining of the stomach, upper intestines, and occasionally the esophagus.
• Although peptic ulcers were previously thought to be caused by stress, they are actually caused by H. pylori bacterial infections or the chronic use of certain medications like NSAIDs.
• They are marked by abdominal pain that may feel worse when your stomach is empty and improves temporarily when you eat or take an antacid.
• In severe cases, peptic ulcers can lead to dangerous symptoms like vomiting blood, blood in the stool, unexplained weight loss, and others.
• If you suspect you have an ulcer, avoid self-medicating and consult a doctor for proper diagnosis and treatment.