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What Is a Peptic Ulcer?

Medically Reviewed by Neha Pathak, MD on September 16, 2021

You have a peptic ulcer if you get open sores in the lining of your stomach or the upper part of the small intestine. That happens when your stomach acids etch away your digestive tract’s protective layer of mucus. You may have no symptoms, or you may feel discomfort or burning pain. Peptic ulcers can lead to internal bleeding, which sometimes can mean you’ll need blood transfusions in the hospital.

You can have two types of peptic ulcer disease:

  • Gastric ulcer. You get this on your stomach lining.
  • Duodenal ulcer. This appears at the top end of the small intestine, an organ that digests and absorbs much of the food you eat.

You can have ulcers at any age, but your chances go up as you get older.

What Causes Peptic Ulcers?

Ulcers form when digestive juices damage the walls of the stomach or small intestine. If the mucus layer gets too thin or your stomach makes too much acid, your gut will feel it. The two major causes are:

  • Bacteria. It’s called Helicobacter pylori (H. pylori), and as many as half of us carry it. Most people infected with H. pylori do not get ulcers. But in others, it can raise the amount of acid, break down the protective mucus layer, and irritate the digestive tract. Experts aren’t sure how H. pylori infection spreads. They think it may pass from person to person through close contact, like kissing. You may also get it from unclean food and water.
  • Certain pain relievers. If you’ve been taking aspirin often and for a long time, you’re more likely to get a peptic ulcer. The same is true for other nonsteroidal anti-inflammatory drugs (NSAIDs). They include ibuprofen and naproxen. NSAIDs block your body from making a chemical that helps protect the inner walls of your stomach and small intestine from stomach acid. Other types of pain meds, such as acetaminophen, won’t lead to peptic ulcers.
  • Smoking cigarettes and drinking alcohol also can make you more likely to get ulcers.  Stress and eating a lot of spicy food don’t cause ulcers, as experts once thought. But they can make ulcers worse and harder to treat.

What Are the Symptoms of a Peptic Ulcer?

You’ll most likely feel a burning pain or discomfort between your belly button and breastbone. You might especially notice it on an empty stomach -- such as between meals or at night. The pain may stop for a little while if you eat or take an antacid, but then return. The pain can last for a few minutes or a few hours, and may come and go for many days or weeks.

Other symptoms may include:

Small ulcers may not cause any symptoms. But if you notice any of these signs, talk to your doctor.

How Is a Peptic Ulcer Diagnosed?

Your doctor will ask about your symptoms, whether you take NSAIDs and other drugs, and medical history. They’ll also check you for bloating in the belly and pain. That may be enough to make a diagnosis.

The only way your doctor can tell for sure if you have an ulcer is to look. They may use a series of X-rays or a test called an endoscopy. This test allows them to pass a thin, bendy tube down your throat and into your stomach and small intestine. The tube has a camera at the end so they can check the lining for ulcers. They may also take a small piece of the lining to test for H. pylori. Blood, breath, and stool sample tests also can screen for the bacteria.

How Is a Peptic Ulcer Treated?

Some peptic ulcers heal on their own. But if you don’t treat them, the ulcers tend to come back.

They can erode the blood vessel wall in your stomach or small intestine. The ulcers also can eat a hole through the lining and get infected. Or they can cause swelling, which may block food from moving from your stomach into your small intestine.

If H. pylori is the culprit, your doctor may prescribe a mix of antibiotics to kill it. If aspirin and other NSAIDs are behind the ulcer, you may need to cut down on them, stop taking them altogether, or switch to another pain reliever.

Your doctor may also give you antacids to fight stomach acid, or prescribe medicine to lessen the acid your body makes. Prescription drugs called cytoprotective agents can help protect the lining of the stomach or small intestine so the ulcer can heal.

Can You Prevent a Peptic Ulcer?

While stress and spicy foods can make symptoms of a peptic ulcer worse, they don’t seem to make you more likely to have one. But a few other things can raise your chances.

Be careful when you take pain relievers. Some people who have arthritis or other conditions that cause chronic pain take nonsteroidal anti-inflammatory drugs (NSAIDs) for weeks or months at a time to ease pain and swelling. These medicines can affect the mucus that protects your stomach against acid and make you more likely to have peptic ulcers.

These pain relievers include:

You're more likely to get an ulcer while taking one of these if you:

  • Are over age 65
  • Are infected with H. pylori bacteria
  • Take more than one NSAID at a time
  • Have had a peptic ulcer in the past
  • Also take a steroid drug or selective serotonin reuptake inhibitor (SSRI)

To lower your chances for peptic ulcers while you take NSAIDs:

  • Use the lowest possible dose to control your symptoms, and stop taking them as soon as you no longer need them.
  • Take your medicine with food.
  • Don't drink alcohol while you’re taking these medicines.

While you're on NSAIDs, you can take medicine to lower the amount of acid your stomach makes. Drugs that can do that include:

You can also take the drug misoprostol (Cytotec) to boost the amount of protective mucus your stomach makes. But that can cause side effects like diarrhea and stomach cramps.

Don’t smoke, and limit alcohol. These two habits make you more likely to get peptic ulcers. Both thin the mucus lining that protects your stomach from acid, leading to more acid.

Ask your doctor to recommend a program to help you quit smoking. And talk with them about how much alcohol is safe for you to drink.

Manage stress. Stress can make the symptoms of a peptic ulcer worse. Figure out what’s causing issues for you and see how you can deal with it better. For example, getting enough sleep can help with that. It also can boost your immune system.

Consider probiotics. Millions of bacteria normally live in your gut. Some, like H. pylori, cause disease. Others are good for you because they help crowd out harmful bacteria. These helpful bacteria are called probiotics.

They’re still being studied, but researchers think they may help with peptic ulcers. You can find them in foods like these:

  • Dairy products that have live cultures, like yogurt, kefir, and aged cheeses
  • Sauerkraut
  • Kimchi
  • Miso
  • Tempeh

Prevent H. pylori infection. About two-thirds of people around the world have this type of infection, but most don’t get ulcers because of it. Doctors don’t know how you can avoid H. pylori, but they think it spreads from person to person or through food or water.

You can do some things to make an infection less likely:

  • Wash your hands often during the day with warm water and soap so you don't catch or spread H. pylori bacteria. Clean your hands before you eat and after you go to the bathroom. If you don't have soap and water close by, use an alcohol-based hand sanitizer.
  • Cook meat and other foods all the way through.
  • Only drink water that you know is clean.
WebMD Medical Reference

Sources

SOURCES:

UpToDate: “Patient education: Peptic ulcer disease (Beyond the Basics).”

American College of Gastroenterology: “Peptic Ulcer Disease.”

Medical University of South Carolina Digestive Disease Center: “Peptic Ulcers.”

Mayo Clinic: “Peptic Ulcer.”

CDC: “Helicobacter pylori.”

National Institute of Diabetes and Digestive and Kidney Diseases: “Peptic Ulcers.”

American Academy of Family Physicians: “Peptic Ulcer Disease.”

Academy of Nutrition and Dietetics: "Prebiotics and Probiotics: Creating a Healthier You."

Harvard Medical School: "Peptic Ulcer."

National Center for Complementary and Integrative Health: "Probiotics: In Depth."

PubMed Health: "Gastritis: How can you prevent peptic ulcers caused by painkillers?"

The Journal of Nutrition: "Helicobacter pylori and probiotics."

The Medical Letter: "Primary Prevention of Ulcers in Patients Taking Aspirin or NSAIDs."

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