What Is a Peptic Ulcer?

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.

Causes

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. But 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.

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Symptoms

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:

  • Bloated feeling
  • Burping
  • Lack of appetite or weight loss
  • Nausea
  • Bloody or dark poop
  • Vomiting

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

Diagnosis

Your doctor will ask about your symptoms, whether you take NSAIDs and other drugs, and medical history. She’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. She may use a series of X-rays or a test called an endoscopy. This test allows her 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 she can check the lining for ulcers. She 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.

Treatment

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.

WebMD Medical Reference Reviewed by William Blahd, MD on September 27, 2017

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.”

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