Understanding Ulcers

Medically Reviewed by Neha Pathak, MD on September 17, 2021
4 min read

There is no clear evidence to suggest that the stress of modern life or a steady diet of fast food causes ulcers in the stomach and small intestine, but they are nonetheless common in our society: About one out of every 10 Americans will suffer from the burning, gnawing abdominal pain of a peptic (or gastric) ulcer at some point in life.

Peptic ulcers are holes or breaks in the protective lining of the duodenum (the upper part of the small intestine) or the stomach -- areas that come into contact with stomach acids and enzymes. Duodenal ulcers are more common than stomach ulcers. Comparatively rare are esophageal ulcers, which form in the esophagus -- or swallowing tube -- and are often a result of exposure to medications, like certain antibiotics or anti-inflammatories, or alcohol abuse.

Until the mid-1980s, the conventional wisdom was that ulcers form as a result of stress, a genetic predisposition to excessive stomach acid secretion, and poor lifestyle habits (including overindulging in rich and fatty foods, alcohol, caffeine, and tobacco). It was believed that such influences contribute to a buildup of stomach acids that erode the protective lining of the stomach, duodenum, or esophagus.

While excessive stomach acid secretion certainly plays a role in the development of ulcers, a relatively recent theory holds that bacterial infection is the primary cause of peptic ulcers. Indeed, research conducted since the mid-1980s has shown that the bacterium Helicobacter pylori(H. pylori) is present in more than 90% of duodenal ulcers and about 80% of stomach ulcers. However, more recent figures indicate those percentages are declining.  

Other factors also seem to contribute to ulcer formation, especially in someone with H. pylori:

  • Overuse of over-the-counter painkillers (such as aspirin, ibuprofen, and naproxen)
  • Heavy alcohol use
  • Psychological stress
  • Smoking

Other studies show that stomach ulcers are more likely to develop in older people. This may be because:

  • Arthritis is prevalent in older people, and alleviating arthritis pain can mean taking daily doses of aspirin or ibuprofen.
  • With advancing age the pylorus (the valve between the stomach and duodenum) relaxes and allows excess bile (a compound produced in the liver to aid in digestion) to seep up into the stomach and erode the stomach lining.

Also, for no known reason, people with type A blood are more likely to develop cancerous stomach ulcers.

Duodenal ulcers tend to appear in people with type O blood, possibly because they do not produce the substance on the surface of blood cells that may protect the lining of the duodenum.

If your doctor thinks you might have a peptic ulcer, they’ll probably start with a physical exam and some tests:

  • They’ll feel your belly and ask if you’ve had things like tenderness, pain, or bloating. They might use a stethoscope to listen to any sounds your stomach is making.
  • The next step will be tests to look for signs of the H. pylori bacteria. Your doctor may take samples of your blood, stool, or breath for these.
  • In some cases, especially if you’re older and your symptoms include things like weight loss or loss of appetite, they might use a long, flexible tube called an endoscope to look down your throat and into your stomach for signs of an ulcer. (You’ll be given medicine to make you sleepy.) An endoscope can also take a small sample of tissue from an ulcer that can be tested in a laboratory.
  • They might ask you to drink a milky liquid called barium before they take X-rays of your stomach. This drink coats your digestive system and makes problems like ulcers show up more clearly.

If you have a peptic ulcer, your doctor will recommend a treatment plan based on what’s causing it:

  • The most common remedy is a combination of antibiotic drugs to kill the H. pylori bacteria and medications to get rid of acid in your stomach. These typically include proton pump inhibitors (like Aciphex or Nexium), and antibiotics. You’ll take PPIs for several weeks.
  • If your ulcer is caused by over-the-counter painkillers, you’ll need to quit taking them.
  • They also may give you a drug called a protectant, which coats ulcers to protect them from stomach acid.

Lifestyle changes can help, too. You might need to:

After treatment, your doctor may want to keep a close eye on you, depending on:

  • The size of your ulcer and where it was
  • How well the treatment worked
  • If you had any other problems

An ulcer can cause serious problems, like stomach bleeding, if it’s not treated. An untreated ulcer also can lead to a hole in your stomach, which may need to be fixed with surgery.