Peptic Ulcer Overview

Peptic ulcer disease (PUD) is a condition of the digestive system in which open sores called peptic ulcers develop in the inner lining of the digestive tract. There are two types of peptic ulcers:

Stomach Ulcers

Stomach ulcers, also called gastric ulcers, develop in the lining of your stomach.

Duodenal Ulcers

Peptic ulcers are called duodenal ulcers when they develop in the duodenum, which is the first part of the small intestine.

Most esophageal ulcers occur due to gastroesophageal reflux disease (GERD) or chronic acid reflux. However, sometimes, peptic ulcer disease can cause an esophageal ulcer in the lower part of the esophagus (the tube that connects the mouth to the stomach).

Symptoms of Peptic Ulcers

Common Symptoms of Stomach Ulcers

Not all stomach ulcers cause symptoms, depending on the severity of the condition. When present, symptoms usually include:

Severe abdominal pain
Gas pain, bloating, or a feeling of fullness soon after eating
Belching or burping
Heartburn or acid reflux
Indigestion or upset stomach
Nausea
Vomiting

Less Common Symptoms of Stomach Ulcers

Bloody vomit or coffee grounds appearance to vomit
Black or tarry stools (dark blood in stools)
Shortness of breath or trouble breathing
Feeling dizzy or faint
Changes in appetite
Unexplained weight loss

Differences in Symptoms of Stomach vs Duodenal Ulcers

People who have a gastric ulcer (stomach ulcer) typically experience abdominal pain within 15-30 minutes of eating. On the other hand, people who have a duodenal ulcer tend to experience abdominal pain 2-3 hours after a meal.

What Does a Stomach Ulcer Feel Like?

A stomach ulcer feels like a sharp abdominal pain—this is the most common symptom. It is usually a burning or gnawing pain in the upper abdomen. Many people describe it as an acid burn or as something eating away at their insides (this occurs because the stomach acid eats away at the stomach lining). The burning pain is usually located in the area between the breastbone and the belly button, a little to the left. It can travel up to your neck, down to your belly button, and around to your back.

Stomach ulcer pain typically occurs within 15-30 minutes of eating but can occur up to 2-3 hours after meals. It can last from a few minutes to a few hours. You can also develop pain between meals and on an empty stomach. You may wake up during the night with stomach pain.

The pain can be accompanied by other symptoms such as bloating, belching, nausea, and heartburn.

How Do I Know If I’m Having An Ulcer?

You can suspect you have an ulcer if you experience a burning stomach pain that is worse with eating fatty foods, acidic foods, or spicy foods (foods that increase the secretion of stomach acid). Another clue that you might have an ulcer is tummy pain that is temporarily relieved by taking over-the-counter antacids or acid blockers or eating certain foods that neutralize stomach acid (for example, milk, bananas, or watery foods like cucumber, celery, and watermelon).

Causes of Stomach Ulcers

A peptic ulcer develops when the mucous layer, which normally protects the lining of your stomach from stomach acids, gets damaged. This allows the stomach acid to eat away at the inner surface of the stomach or duodenum and form an open sore or ulcer. Common causes of stomach and duodenal ulcers include:

Helicobacter Pylori Infection

Bacteria called Helicobacter pylori (also called H. pylori or H. pylorus) are present in the stomach and intestines of up to 50% of the world’s population. H. pylori infection spreads from person to person through saliva, stool, and vomit. The bacterium can also spread through contaminated food and water.

In most people, Helicobacter pylori bacteria don’t cause problems. But in some people, the bacterium causes inflammation in the inner lining of the stomach and formation of an ulcer. H. pylori bacterial infection is the most common cause of peptic ulcers.

Overuse of NSAIDs

Regular use or taking higher than recommended doses of certain over-the-counter and prescription pain medications called nonsteroidal anti-inflammatory drugs (NSAIDs) can cause irritation and inflammation of the lining of the digestive tract and the formation of stomach ulcers. Examples of NSAIDs include aspirin, ibuprofen (Motrin, Advil), naproxen (Naprosyn, Aleve), diclofenac, and others. Acetaminophen (Tylenol) is recommended for those with peptic ulcers or a history of this condition because it does not irritate the stomach lining, leading to a stomach ulcer.

Taking certain other medications along with NSAIDs, such as blood thinners (anticoagulants), steroids, low-dose aspirin, alendronate (Fosamax), risedronate (Actonel), and certain antidepressants (selective serotonin reuptake inhibitors or SSRIs), can increase the risk of bleeding peptic ulcers.

H. pylori infection, along with NSAID use, is linked to an increased risk of developing a bleeding ulcer.

Other Causes

Less common causes of stomach ulcers include:

Zollinger-Ellison syndrome, which is a rare condition in which tumors called gastrinomas cause the lining of your stomach to produce too much acid
Infections other than H. pylori, including other gastric Helicobacter species that may be acquired through direct contact with animals
Stomach cancer
Other diseases, such as small intestine Crohn's disease

Risk Factors

Alcohol consumption can increase the amount of stomach acid and irritate the lining of your stomach, increasing your risk of stomach ulcers.
Smoking is associated with an increased risk of peptic ulcers in people infected with H. pylori.
Stress can increase stomach acid production. In addition, people with untreated stress tend to use more over-the-counter pain medications (NSAIDs) to manage aches and pains. Also, stress can trigger tobacco and alcohol use, which are also risk factors for stomach ulcers.
Spicy foods don’t cause stomach ulcers but can make symptoms worse if you have ulcers. In fact, research shows spicy foods may actually prevent stomach ulcers by stopping the growth of H. pylori bacteria. In addition, spicy foods contain capsaicin, which is alkaline and prevents excess stomach acid.

When to See a Doctor

You should see a doctor if you have any of the symptoms of stomach ulcers. Left untreated, stomach and duodenal ulcers can lead to serious and potentially life-threatening complications, including severe blood loss due to internal bleeding if a peptic ulcer bleeds, a perforation (hole) in the stomach wall, digestive tract obstruction (blockage), and gastric cancer (H. pylori infection is a risk factor for stomach cancer).

Diagnosis of Stomach Ulcers

Tests and Procedures

Your healthcare provider can diagnose a stomach ulcer based on your medical history, physical exam, and diagnostic tests, including:

Blood test, stool test, and urea breath test for H. pylori infection
Upper endoscopy to visualize the lining of your stomach and duodenum and obtain a tissue sample (biopsy) to look for H. pylori bacteria
A set of X-rays called an upper gastrointestinal series or barium swallow to obtain images of your esophagus, stomach, and small intestine.

How Do You Check Yourself For A Stomach Ulcer?

You cannot check yourself for a stomach ulcer—only your healthcare provider can tell you for sure if you have a stomach ulcer. However, you can purchase a home test kit for H. pylori bacteria. This is a blood test that you do at home with an easy-to-use kit that gives you the result in 10-15 minutes.

Treatment Options for Stomach Ulcers

The goals of treatment for peptic ulcers consist of treating H. pylori infection if present, stopping or reducing the use of NSAIDs, and helping an ulcer to heal with medications that protect the lining of your stomach.

Lifestyle Changes

Avoid foods and beverages that cause worsening of your symptoms. These may include alcohol, coffee, caffeinated sodas and beverages, chocolate, fatty foods, and spicy and acidic foods.
Avoid large meals and late-night snacking.
Try to quit smoking if you smoke.
Manage your stress levels.
Avoid taking over-the-counter pain relievers such as aspirin, ibuprofen, and naproxen. Take acetaminophen (Tylenol) instead for pain and fever. Take your medicines with plenty of water to lower the risk of stomach irritation.
Talk to your doctor if you have questions regarding the types of OTC pain relievers and how much you should take. While NSAIDs are not recommended due to the increased risk of PUD, acetaminophen (Tylenol) also must be used with caution if you have liver disease. Your healthcare provider can guide you on the type and dosing of OTC pain relief to treat minor aches, pain, or fever.

Medications to Treat Ulcers

Some of the medications prescribed for stomach ulcer treatment include:

Antibiotics for H. pylori Infection

Antibiotics such as clarithromycin (Biaxin), tetracycline, levofloxacin, amoxicillin (Amoxil), metronidazole (Flagyl), and tinidazole (Tindamax) are used to kill the H. pylori bacteria.

Triple therapy for H. pylori bacteria includes antibiotics in combination with a proton pump inhibitor (PPI). Examples include Omeclamox-Pak (omeprazole, amoxicillin, clarithromycin) and Prevpac (lansoprazole, amoxicillin, clarithromycin).

Quadruple therapy for H. pylori infection may include a PPI such as pantoprazole plus three antibiotics—amoxicillin, clarithromycin, and metronidazole. Another combination is lansoprazole, bismuth subsalicylate, metronidazole, and tetracycline. Your doctor will choose the best H. pylori treatment based on current antibiotic resistance rates in your area. You'll likely need to take the medications for two weeks, but you may need to take a PPI for up to 8 weeks if your ulcer was caused by taking an NSAID.

Proton Pump Inhibitors

Proton pump inhibitors (PPIs) are a group of drugs that reduce stomach acid production. They are available both over-the-counter and by prescription. Examples include pantoprazole (Protonix), omeprazole (Prilosec), esomeprazole (Nexium), rabeprazole (Aciphex), and lansoprazole (Prevacid).

Side effects of long-term PPI use include an increased risk of osteoporosis. Your doctor may prescribe a calcium supplement to lower this risk.

Acid Blockers

Acid blockers or histamine (H2) blockers lower the amount of stomach acid. They relieve ulcer pain and promote healing. H2 blockers are available over-the-counter and by prescription. Examples include cimetidine (Tagamet HB), famotidine (Pepcid AC), and nizatidine (Axid AR).

Antacids

Antacids are drugs that neutralize stomach acids and provide fast relief from symptoms of a stomach/duodenal ulcer. However, they do not help an ulcer heal. Examples include Tums, Mylanta, Rolaids, and Pepto-Bismol.

Cytoprotective Agents

Your gastroenterologist (a doctor who specializes in gastrointestinal and liver disease diagnosis and treatment) may give you prescription medications such as sucralfate (Carafate) and misoprostol (Cytotec). These drugs protect the stomach lining and help ulcers heal.

Surgery

Most ulcers can be treated with medications, and surgery is rarely needed. However, you may need to undergo ulcer surgery for stomach ulcer complications such as gastrointestinal bleeding or stomach perforation.

Can a Stomach Ulcer Heal on Its Own?

A stomach ulcer may heal on its own after you stop taking NSAIDs if the ulcer was caused by NSAID overuse. But if your ulcer is due to an H. pylori infection, it is unlikely to heal on its own without antibiotic therapy.

Will A Stomach Ulcer Go Away On Its Own?

A stomach ulcer may go away on its own if you stop whatever caused it, for example, regular use of pain-relieving medications. However, it is important to seek medical care for stomach ulcer symptoms. Your healthcare provider can identify the cause and treat it appropriately. If the cause is an H. pylori infection, for instance, you'll need prescription antibiotic treatment to make the stomach ulcer go away.

How to Prevent Peptic Ulcers?

You can lower your risk of stomach ulcers with the following strategies:

Protect yourself from H. pylori infection by washing your hands, cleaning food preparation surfaces frequently, and cooking food to the proper temperature.
Use pain medications at the lowest dose and for the shortest time for pain relief. Do not take more than the recommended dose mentioned on the package or prescription label. Take your pain medications with meals and a full glass of water. Call your doctor if you have chronic pain and need to take over-the-counter pain relievers frequently.
Avoid drinking alcohol, especially when taking pain medications.
Talk to your doctor about taking a proton pump inhibitor, acid blocker, or cytoprotective agent if you need to take NSAIDs long-term. Also, consider taking cyclooxygenase-2 (COX-2) inhibitors, a type of NSAID that is less likely to cause stomach ulcers.

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