Peptic ulcer disease refers to painful sores or ulcers in the lining of the stomach or first part of the small
intestine, called the duodenum.
What Causes Ulcers?
No single cause has been found for ulcers. However, it is now clear that an ulcer is the end result of an
imbalance between digestive fluids in the stomach and duodenum. Ulcers can be caused by:
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Infection with a type of bacteria called Helicobacter pylori (H. pylori)
Use of painkillers called nonsteroidal anti-inflammatory drugs (NSAIDs), such
as aspirin, naproxen (Aleve, Anaprox, Naprosyn, and others), ibuprofen
(Motrin, Advil, Midol, and others), and many others available by prescription.
Even safety-coated aspirin and aspirin in powered form can frequently cause
ulcers.
Excess acid production from gastrinomas, tumors of the acid producing cells
of the stomach that increases acid output (seen in Zollinger-Ellison
syndrome).
What Are the Symptoms of an Ulcer?
An ulcer may or may not have symptoms. When symptoms occur, they may include:
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A gnawing or burning pain in the middle or upper stomach between meals or
at night
Bloating
Heartburn
Nausea or vomiting
In severe cases, symptoms can include:
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Dark or black stool (due to bleeding)
Vomiting blood (that can look like "coffee-grounds")
Weight loss
Severe pain in the mid to upper abdomen
How Are Ulcers Treated?
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If not properly treated, ulcers can lead to serious health problems. There are several ways in
which ulcers can be treated, including making changes to ones lifestyle, limiting dairy, taking
medication, and/or undergoing surgery
Ulcer Medications
Ulcer medications can include:
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Proton pump inhibitors (PPI). Proton pump medications reduce acid levels
and allow the ulcer to heal. They include Prilosec, Prevacid, Aciphex,
Protonix, Zegerid, Dexilant, and Nexium.
Antibiotics. If you have H. pylori infection, then antibiotics are used. There
are multiple combinations of antibiotics that are taken for one to two weeks
along with a PPI. Pepto-Bismol is also part of some treatment regimens.
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Upper endoscopy. Some bleeding ulcers can be treated through an
endoscope.
Surgery. Sometimes an operation is needed if the ulcer has created a hole
in the wall of the stomach or if there is serious bleeding that can't be
controlled with an endoscope.
Definition
Peptic ulcers are open sores that develop on the inside lining of your esophagus, stomach and the upper
portion of your small intestine. The most common symptom of a peptic ulcer is abdominal pain.
Peptic ulcers that occur on the inside of the stomach are called gastric ulcers. Peptic ulcers that occur
inside the hollow tube (esophagus) where food travels from your throat to your stomach are called
esophageal ulcers. Peptic ulcers that affect the inside of the upper portion of your small intestine
(duodenum) are called duodenal ulcers.
It's a myth that spicy foods or a stressful job can cause peptic ulcers. Doctors now know that a bacterial
infection or some medications — not stress or diet — cause most peptic ulcers.
Symptoms
Pain is the most common symptom
Burning pain is the most common peptic ulcer symptom. The pain is caused by the ulcer and is
aggravated by stomach acid coming in contact with the ulcerated area. The pain typically may:
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Be felt anywhere from your navel up to your breastbone
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Be worse when your stomach is empty
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Flare at night
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Often be temporarily relieved by eating certain foods that buffer stomach acid or by taking an acidreducing medication
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Disappear and then return for a few days or weeks
Other signs and symptoms
Less often, ulcers may cause severe signs or symptoms such as:
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The vomiting of blood — which may appear red or black
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Dark blood in stools or stools that are black or tarry
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Nausea or vomiting
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Unexplained weight loss
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Appetite changes
When to see a doctor
See your doctor if you have persistent signs and symptoms that worry you. Over-the-counter antacids
and acid blockers may relieve the gnawing pain, but the relief is short-lived. If your pain persists, see your
doctor.
Causes
Peptic ulcers occur when acid in the digestive tract eats away at the inner surface of the esophagus,
stomach or small intestine. The acid can create a painful open sore that may bleed.
Your digestive tract is coated with a mucous layer that normally protects against acid. But if the amount of
acid is increased or the amount of mucus is decreased, you could develop an ulcer. Causes include:
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A bacterium. A common cause of ulcers is the corkscrew-shaped bacterium Helicobacter pylori. H. pylori
bacteria commonly live and multiply within the mucous layer that covers and protects tissues that line the
stomach and small intestine. Often, H. pylori causes no problems. But sometimes it can disrupt the
mucous layer and inflame the lining of your stomach or duodenum, producing an ulcer. It's not clear how
H. pylori spreads. It may be transmitted from person to person by close contact, such as kissing. People
may also contract H. pylori through food and water.
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Regular use of pain relievers. Certain over-the-counter and prescription pain medications can irritate or
inflame the lining of your stomach and small intestine. These medications include aspirin, ibuprofen
(Advil, Motrin, others), naproxen (Aleve, Anaprox, others), ketoprofen and others. Peptic ulcers are more
common in older adults who take pain medications frequently, such as might be common in people with
osteoarthritis. To help avoid digestive upset, take pain relievers with meals. If you have been diagnosed
with an ulcer, make sure your doctor knows this when prescribing any pain reliever. The pain reliever
acetaminophen (Tylenol, others) doesn't cause peptic ulcers.
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Other medications. Other prescription medications that can also lead to ulcers include medications used
to treat osteoporosis called bisphosphonates (Actonel, Fosamax, others).
Risk Factors
You may have an increased risk of peptic ulcers if you:
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Smoke. Smoking may increase the risk of peptic ulcers in people who are infected with H. pylori.
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Drink alcohol. Alcohol can irritate and erode the mucous lining of your stomach, and it increases the
amount of stomach acid that's produced.
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Have uncontrolled stress. Although stress alone isn't a cause of peptic ulcers, it's a contributing factor.
You may undergo stress for a number of reasons — an emotionally disturbing circumstance or event,
surgery, or a physical trauma, such as a burn or other severe injury.
Treatments
Treatment for peptic ulcers typically involves antibiotics to kill the H. pylori bacterium and other
medications to reduce the level of acid in your digestive system to relieve pain and encourage healing.
You may take antibiotics for two weeks and acid-reducing medications for about two months.
If your peptic ulcer isn't caused by H. pylori, you won't need antibiotics. Instead, your doctor may
recommend treatments for your specific situation. For instance, if pain relievers caused your ulcer, your
doctor may recommend a different pain reliever or a different dose. Your doctor may also recommend
acid-reducing medications to allow your ulcer to heal. You may take these medications for two months or
more.
Treatments for peptic ulcer can include:
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Antibiotic medications to kill H. pylori. If H. pylori is found in your digestive tract, your doctor may
recommend a combination of antibiotics to kill the bacterium. Antibiotic regimens are different throughout
the world. In the United States, antibiotics prescribed for treatment of H. pylori include amoxicillin,
clarithromycin (Biaxin), metronidazole (Flagyl) and tetracycline. You'll likely need to take antibiotics for
two weeks.
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Medications that block acid production and promote healing. Proton pump inhibitors reduce acid by
blocking the action of the parts of cells that produce acid. These drugs include the prescription and overthe-counter medications omeprazole (Prilosec), lansoprazole (Prevacid), rabeprazole (Aciphex),
esomeprazole (Nexium) and pantoprazole (Protonix). Long-term use of proton pump inhibitors,
particularly at high doses, may increase your risk of hip, wrist and spine fracture. Ask your doctor whether
a calcium supplement may reduce this risk.
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Medications to reduce acid production. Acid blockers — also called histamine (H-2) blockers —
reduce the amount of acid released into your digestive tract, which relieves ulcer pain and encourages
healing. Available by prescription or over-the-counter (OTC), acid blockers include the medications
ranitidine (Zantac), famotidine (Pepcid), cimetidine (Tagamet) and nizatidine (Axid).
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Antacids that neutralize stomach acid. Your doctor may include an antacid in your drug regimen.
Antacids neutralize existing stomach acid and can provide rapid pain relief. Side effects can include
constipation or diarrhea, depending on the main ingredients.
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Medications that protect the lining of your stomach and small intestine. In some cases, your doctor
may prescribe medications called cytoprotective agents that help protect the tissues that line your
stomach and small intestine. They include the prescription medications sucralfate (Carafate) and
misoprostol (Cytotec). Another nonprescription cytoprotective agent is bismuth subsalicylate (PeptoBismol).
Side Effects
Side Effects of Antibiotics.
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The most common side effects of nearly all antibiotics are gastrointestinal problems, including
cramps, nausea, vomiting, and diarrhea.
 Allergic reactions can also occur with all antibiotics but are most common with medications derived
from penicillin or sulfa. These reactions can range from mild skin rashes to rare but severe, even
life-threatening anaphylactic shock.
 Some drugs, including certain over-the-counter medications, interact with antibiotics; patients
should report to the physician all medications they are taking.
 They double the risk for vaginal infections in women.