Peptic Ulcer: Causes, Symptoms, Treatment & Prevention
Peptic Ulcer: Causes, Symptoms, Treatment & Prevention
A peptic ulcer is a sore that develops on the lining of the stomach, the upper part of the small intestine (duodenum), or—less commonly—the esophagus. While once thought to be caused primarily by stress or spicy food, we now know that most peptic ulcers result from infection or certain medications. The good news? With proper diagnosis and treatment, most ulcers heal completely.
This guide explains what peptic ulcers are, what causes them, how to recognize the symptoms, and what treatments work best—all in plain language for everyday readers.
What Is a Peptic Ulcer?
A peptic ulcer is an open sore that forms when the protective mucus layer in your digestive tract is weakened. This allows stomach acid to eat away at the sensitive lining underneath. There are two main types:
- Gastric ulcer: Occurs in the stomach.
- Duodenal ulcer: Occurs in the first part of the small intestine (duodenum).
Duodenal ulcers are more common than gastric ulcers, and both are collectively called “peptic ulcers” because they’re related to pepsin and acid—two key digestive substances.
What Causes Peptic Ulcers?
Contrary to popular belief, spicy food and stress do not cause ulcers—but they can worsen symptoms. The two main causes are:
1. Helicobacter pylori (H. pylori) Infection
This bacterium lives in the mucus layer of the stomach and duodenum. In many people, it causes no issues. But in others, it triggers inflammation and weakens the mucus barrier, allowing acid to damage the underlying tissue.
According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), H. pylori is responsible for up to 90% of duodenal ulcers and 70–90% of gastric ulcers.
2. Long-Term Use of NSAIDs
Nonsteroidal anti-inflammatory drugs (NSAIDs)—like ibuprofen (Advil®, Motrin®), naproxen (Aleve®), and aspirin—can irritate or erode the stomach lining, especially when taken regularly or in high doses.
People over 60, those with a history of ulcers, or those taking corticosteroids or blood thinners are at higher risk when using NSAIDs.
Myth Busting: While stress doesn’t cause ulcers, severe physiological stress (e.g., from major surgery, burns, or critical illness) can lead to “stress ulcers”—but these are different from typical peptic ulcers and occur in hospitalized patients.
Symptoms of Peptic Ulcers
Not everyone with a peptic ulcer has symptoms. But when they do appear, the most common sign is:
- Burning stomach pain—often between the belly button and chest—that may:
- Come and go over days or weeks
- Worsen when the stomach is empty
- Improve temporarily after eating or taking antacids
Other possible symptoms include:
- Bloating or feeling full quickly
- Heartburn
- Nausea or vomiting
- Loss of appetite
- Unintended weight loss
When to Seek Emergency Care
Some ulcer complications are medical emergencies. Seek immediate help if you experience:
- Vomiting blood (may look like coffee grounds)
- Black, tarry, or bloody stools
- Sudden, severe abdominal pain
- Dizziness or fainting
These signs may indicate bleeding, perforation (a hole in the stomach/intestine), or obstruction—all requiring urgent treatment.
How Are Peptic Ulcers Diagnosed?
Doctors use a combination of medical history, physical exam, and tests:
1. Tests for H. pylori
- Breath test: You drink a special solution and exhale into a bag; the presence of H. pylori changes the breath sample’s composition.
- Stool test: Detects H. pylori antigens in feces.
- Blood test: Less common now; shows antibodies but can’t distinguish current vs. past infection.
2. Endoscopy (Upper GI Endoscopy)
A thin, flexible tube with a camera (endoscope) is passed through your mouth into the stomach and duodenum. This allows the doctor to:
- See ulcers directly
- Take biopsies (small tissue samples) to test for H. pylori or cancer
Endoscopy is often recommended for people over 55, or those with “alarm symptoms” like weight loss, vomiting, or anemia.
3. Imaging Tests
In some cases, a barium swallow X-ray may be used. You drink a chalky liquid (barium) that coats the digestive tract, making ulcers visible on X-rays.
Treatment Options
Treatment depends on the cause. The goals are to:
- Eradicate H. pylori (if present)
- Reduce stomach acid
- Allow the ulcer to heal
- Prevent recurrence
1. For H. pylori-Related Ulcers: Antibiotic Therapy
A combination of two antibiotics (e.g., amoxicillin + clarithromycin) plus a proton pump inhibitor (PPI) is typically prescribed for 10–14 days. This is called “triple therapy.” Sometimes bismuth (Pepto-Bismol®) is added (“quadruple therapy”).
It’s critical to complete the full course—even if you feel better—to prevent antibiotic resistance.
2. Acid-Reducing Medications
- Proton Pump Inhibitors (PPIs): Omeprazole (Prilosec®), esomeprazole (Nexium®), lansoprazole (Prevacid®). These drastically reduce acid production and promote healing.
- H2 Blockers: Famotidine (Pepcid®), ranitidine (formerly Zantac®). Less potent than PPIs but still effective.
- Antacids: Provide quick, temporary relief but don’t heal ulcers.
3. Lifestyle and Dietary Adjustments
While diet doesn’t cause ulcers, certain choices can support healing:
- Avoid NSAIDs—use acetaminophen (Tylenol®) instead for pain relief when possible.
- Limit alcohol—it irritates the stomach lining.
- Quit smoking—smoking delays healing and increases recurrence risk.
- Manage stress through exercise, mindfulness, or therapy (though stress isn’t a direct cause, it can worsen symptoms).
There’s no need to avoid spicy foods unless they personally trigger discomfort.
Complications of Untreated Ulcers
Ignoring an ulcer can lead to serious problems:
- Bleeding: The most common complication. Can cause anemia or life-threatening blood loss.
- Perforation: The ulcer burns through the stomach or intestinal wall, spilling contents into the abdomen—requiring emergency surgery.
- Obstruction: Scar tissue from a healing ulcer can block food from passing through the digestive tract, causing vomiting and weight loss.
Early treatment prevents these outcomes in nearly all cases.
Prevention Tips
You can reduce your risk of developing a peptic ulcer by:
- Using NSAIDs only when necessary—and at the lowest effective dose.
- Taking a PPI or misoprostol (a protective medication) if you must use NSAIDs long-term.
- Practicing good hygiene (e.g., handwashing) to reduce H. pylori transmission—though how it spreads isn’t fully understood.
- Avoiding smoking and excessive alcohol.
Prognosis: Can Ulcers Be Cured?
Yes! With proper treatment, most peptic ulcers heal within weeks. H. pylori eradication significantly reduces the chance of recurrence—from 60–90% down to less than 10%.
However, ulcers caused by NSAIDs may return if NSAID use continues. Always discuss pain management alternatives with your doctor.
References
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Peptic Ulcers (Stomach Ulcers).
- Mayo Clinic. Peptic Ulcer: Symptoms & Causes.
- Centers for Disease Control and Prevention (CDC). Helicobacter pylori.
- National Center for Biotechnology Information (NCBI). Peptic Ulcer Disease.
- World Gastroenterology Organisation. H. pylori and Peptic Ulcer Disease.
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