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Peptic ulcer

A peptic ulcer is an open sore or raw area in the lining of the stomach or intestine.

  • A gastric ulcer occurs in the stomach.
  • A duodenal ulcer occurs in the first part of the small intestine.
Location of peptic ulcers

Alternative Names

Ulcer - peptic; Ulcer - duodenal; Ulcer - gastric; Duodenal ulcer; Gastric ulcer; Dyspepsia - ulcers

Causes

Normally, the lining of the stomach and small intestines can protect itself against strong stomach acids. But if the lining breaks down, the result may be:

  • Swollen and inflamed tissue, called (gastritis )
  • An ulcer
Stomach ulcer
Stomach ulcer

Most ulcers occur in the first layer of the inner lining. A hole that goes all the way through the stomach or duodenum is called a perforation . A perforation is a medical emergency.

Ulcer emergencies

The most common cause of ulcers is infection of the stomach by bacteria called Helicobacter pylori (H.pylori). Most people with peptic ulcers have these bacteria living in their digestive tract. Yet, many people who have these bacteria in their stomach do not develop an ulcer.

The following factors raise your risk for peptic ulcers:

  • Drinking too much alcohol
  • Regular use of aspirin, ibuprofen, naproxen, or other nonsteroidal anti-inflammatory drugs (NSAIDs). Taking aspirin or NSAIDs once in a while is safe for most people.
  • Smoking cigarettes or chewing tobacco
  • Being very ill, such as being on a breathing machine
  • Having radiation treatments

A rare condition called Zollinger-Ellison syndrome causes stomach and duodenal ulcers.

Cause of peptic ulcers

Many people believe that stress causes ulcers. It is not clear if this is true for normal stress.

Symptoms

Small ulcers may not cause any symptoms. Some ulcers can cause serious bleeding.

Abdominal pain is a common symptom. The pain can differ from person to person, and some people have no pain.

Other symptoms include:

  • Feeling of fullness and problems drinking as much fluid as usual
  • Hunger and an empty feeling in the stomach, often 1 - 3 hours after a meal
  • Mild nausea that may go away with vomiting
  • Pain or discomfort in the upper abdomen
  • Pain in the upper abdomen that wakes you up at night

Other possible symptoms include:

Exams and Tests

To diagnose an ulcer, your doctor may perform a test called an upper endoscopy (EGD).

  • This is a test to examine the lining of the esophagus (the tube that connects your throat to your stomach), stomach, and first part of the small intestine.
  • It is done with a small camera (flexible endoscope) that is inserted down the throat.
Gastroscopy procedure

Upper endoscopy is done on most people when peptic ulcers are suspected or when you:

  • Are older than 45 to 50
  • Have a low blood count (anemia)
  • Have trouble swallowing
  • Are vomiting blood or your stools are blood or dark and tarry looking
  • Have been losing weight without trying

Tests for H. pylori is also needed.

Your doctor may also order these tests:

Sometimes, you may need a test called an upper GI . A series of x-rays are taken after you drink a thick substance called barium.

Treatment

In order for your ulcer to heal and to reduce the chance it will come back, you will be given medicines to:

  • Kill the H. pylori bacteria (if present)
  • Reduce acid levels in the stomach

Take all of your medicines as your doctor recommends. Other changes in your lifestyle can also help.

If you have a peptic ulcer with an H. pylori infection, the standard treatment uses different combinations of the following medications for 7- 14 days:

  • Two different antibiotics to kill H. pylori
  • Proton pump inhibitors such as omeprazole (Prilosec), lansoprazole (Prevacid), or esomeprazole (Nexium)
  • Bismuth (the main ingredient in Pepto-Bismol) may be added to help kill the bacteria

If you have an ulcer without an H. pylori infection, or one that is caused by taking aspirin or NSAIDs, your doctor will likely prescribe a proton pump inhibitor for 8 weeks.

You may also be prescribed this type of medicine if you must continue taking aspirin or NSAIDs for other health conditions.

Other medicines used for ulcers are:

  • Misoprostol, a drug that may help prevent ulcers in people who take NSAIDs on a regular basis
  • Medicines that protect the tissue lining (such as sucralfate)

If a peptic ulcer bleeds a lot, an EGD may be needed to stop the bleeding. Methods used to stop the bleeding include:

  • Injecting medicine in the ulcer
  • Applying metal clips to the ulcer

Surgery may be needed if:

  • Bleeding cannot be stopped with an EGD
  • The ulcer has caused a tear

Outlook (Prognosis)

Peptic ulcers tend to come back if untreated. There is a good chance that the H. pylori infection will be cured if you take your medicines and follow your doctor’s treatment advice. You will be much less likely to get another ulcer.

Possible Complications

  • Severe blood loss
  • Scarring from an ulcer may make it harder for the stomach to empty
  • Perforation or hole of the stomach and intestines

When to Contact a Medical Professional

Get medical help right away if you:

  • Develop sudden, sharp abdominal pain
  • Have a rigid, hard abdomen that is tender to touch
  • Have symptoms of shock , such as fainting, excessive sweating, or confusion
  • Vomit blood or have blood in your stool (especially if it's maroon or dark, tarry black)

Call your doctor if:

  • You feel dizzy or light-headed
  • You have ulcer symptoms

Prevention

Avoid aspirin, ibuprofen, naproxen, and other NSAIDs. Try acetaminophen instead. If you must take such medicines, talk to your doctor first. Your doctor may:

  • Test you for H. pylori before you take these medicines
  • Have you take proton pump inhibitors (PPIs) or an acid blocker
  • Have you take a drug called misoprostol

The following lifestyle changes may help prevent peptic ulcers:

  • Do not smoke or chew tobacco.
  • Limit alcohol to no more than two drinks per day.

References

Kuipers EJ, Blaser MJ. Acid peptic disease. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 141.

Chan FKL, Lau JYW. Peptic ulcer disease. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 53.

Chey WD, Wong BC. American College of Gastroenterology guideline on the management of Helicobacter pylori infection. Am J Gastroenterol. 2007;102:1808-1825.

Lanza FL, Chan FK, Quigley EM; Practice Parameters Committee of the American College of Gastroenterology. Guidelines for prevention of NSAID-related ulcer complications. Am J Gastroenterol. 2009;104:728-738.

McColl KEL. Helicobacter pylori infection. NEJM. 2010;362:1597-1604.

Updated: 7/18/2013

George F. Longstreth, MD, Department of Gastroenterology, Kaiser Permanente Medical Care Program, San Diego, California. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.


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