A peptic ulcer is a sore in the inner lining of the stomach or upper small intestine.
Ulcers form when the intestine or stomach's protective layer is broken down. When this happens, digestive juices—which contain hydrochloric acid and an enzyme called pepsin—can damage the intestine or stomach tissue.
Treatment cures most ulcers. And symptoms usually go away quickly.
Peptic ulcers that form in the stomach are called gastric ulcers. Those that form in the upper small intestine are called duodenal (say "doo-uh-DEE-nul" or "doo-AW-duh-nul") ulcers.
The two most common causes of peptic ulcers are:
H. pylori and NSAIDs break down the stomach or intestine's protective mucus layer.
Different people have different symptoms, and some people have no symptoms at all.
Your doctor will ask you questions about your symptoms and your general health, and he or she will do a physical examination.
If your symptoms aren't severe and you are younger than 55, your doctor may do some simple tests (using your blood, breath, or stool) to look for signs of H. pylori infection.
The only way for you and your doctor to know for sure if you have an ulcer is to do a more complicated test, called an endoscopy, to look for an ulcer and to test for H. pylori infection. An endoscopy allows the doctor to look inside your esophagus, stomach, and small intestine. An endoscopy is usually done by a gastroenterologist, a doctor who specializes in digestive diseases. Instead of an endoscopy, your doctor may do an upper gastrointestinal (UGI) series, which is an X-ray examination of the esophagus and stomach.
To treat peptic ulcers, most people need to take medicines that reduce the amount of acid in the stomach. If you have an H. pylori infection, you will also need to take antibiotics.
You can help speed the healing of your ulcer and prevent it from coming back if you quit smoking and limit alcohol. Continued use of medicines such as aspirin, ibuprofen, or naproxen may increase the chance of your ulcer coming back.
Ignoring symptoms of an ulcer is not a good idea. This condition needs to be treated. While symptoms can go away for a short time, you may still have an ulcer. Left untreated, an ulcer can cause life-threatening problems. Even with treatment, some ulcers may come back and may need more treatment.
A rare cause of peptic ulcers is Zollinger-Ellison syndrome. In this condition, the stomach makes too much acid, damaging the stomach lining.
Common ulcer symptoms include:
Less common but more serious symptoms of ulcers include:
Symptoms of ulcers in the upper small intestine (duodenal ulcers) and in the stomach (gastric ulcers) are similar, except for when pain occurs.
Some ulcers don't cause symptoms. These are known as silent ulcers. Silent ulcers are more common in:
In children, symptoms vary with age:
The symptoms of an ulcer often can be confused with other abdominal conditions, such as dyspepsia or gastro esophageal reflux disease (GERD).
Many people who have peptic ulcers may not see a doctor when their symptoms begin. Their symptoms, such as belly pain, may come and go. Even without treatment, some ulcers will heal by themselves.
And even with treatment, ulcers sometimes come back. Certain factors such as cigarette smoking and continued use of non-steroidal anti-inflammatory drugs (NSAIDs) increase the risk of ulcers coming back.
Sometimes ulcers can cause complications, such as bleeding, perforation, penetration, or obstruction. That's why it's important to treat an ulcer, even if you have one that isn't causing any symptoms.
Most peptic ulcers without complications heal, regardless of the cause. But an ulcer is likely to come back if you have an H. pylori infection that is not successfully treated. Recurring ulcers caused by reinfection with H. pylori are not common in Canada and the United States, except in areas that are overcrowded or have poor sanitation.
Ulcers in the stomach (gastric ulcers) often heal more slowly than ulcers in the upper small intestine (duodenal ulcers).
The following things can increase your chance of getting a peptic ulcer and may slow the healing of an ulcer you already have:
In the past, spicy foods, caffeine, and moderate amounts of alcohol were thought to increase ulcer risk. This is no longer believed to be true.
Some things that you cannot control may increase your risk of getting an ulcer. These include:
If you have been diagnosed with a peptic ulcer, call 911 or other emergency services immediately if you have:
Call your doctor or seek medical attention right away if you have:
Call your doctor if you have been diagnosed with a peptic ulcer and:
If you have been diagnosed with a peptic ulcer and medical treatment is not helping, call your doctor. Waiting until your symptoms get worse can be serious.
If you don't know if you have a peptic ulcer and you don't have any of the emergency symptoms listed above, you may try taking an antacid or non-prescription acid reducer and other home treatment, such as making changes to your diet.
To evaluate your symptoms, see your family doctor, general practitioner, or pediatrician (for children and teens).
If further testing or treatment is needed, you may need to see someone who specializes in the treatment of diseases of the digestive tract (gastroenterologist).
If surgery is needed, your doctor may refer you to a general surgeon. But surgery is rarely needed to treat ulcers.
Although not all peptic ulcers are caused by bacteria, it's getting more common to do a test forHelicobacter pylori whenever someone has ulcer symptoms. This includes testing your blood, breath, stool, or a sample of tissue from your digestive tract (biopsy).
An endoscopy may be done so that a doctor can:
If you are older than 55, you may need an endoscopy because of a higher risk for stomach cancer. This is especially true if you have:
Other tests that may be done include:
Left untreated, many ulcers eventually heal. But ulcers often recur if the cause of the ulcer is not eliminated or treated. If ulcers keep coming back, you have an increased risk of developing a serious complication, such as bleeding or a hole in the wall of your stomach or intestine.
Most of the time, treatment means taking medicines—such as H2 blockers and proton pump inhibitors (PPIs)—and making lifestyle changes, including:
If your ulcer is caused by Helicobacter pylori ( H. pylori) bacteria, treatment usually involves a combination of medicines, including antibiotics.
If treatment isn't working, you may need more tests to look for bacteria. If you still have an H. pylori infection, your doctor will likely try a different combination of medicines. He or she may also suggest that you see a gastroenterologist. This specialist will do an endoscopy to look at your ulcer and to take a tissue sample (biopsy).
If you have serious complications from a peptic ulcer, such as bleeding or obstruction, you may need an endoscopy, even if you have already had one.
If your stomach or intestine has a perforation or your ulcer continues to bleed despite treatment, you may need surgery. But surgery is rarely used to treat an ulcer.
You can greatly reduce the chance that you will get a peptic ulcer if you:
Many people who have mild ulcer symptoms first try home treatment for a short time without seeing a doctor.
But see your doctor if your symptoms don't get better after 10 to 14 days of home treatment, or if you have other symptoms such as weight loss, nausea after eating, or consistent pain. This is even more important if you are middle-aged or older, because the risk for cancer or other illnesses that cause symptoms similar to peptic ulcer disease increases with age.
Try these home treatment steps to stop symptoms and help an ulcer heal:
Medicines are used to:
Medicines to reduce stomach acid
Medicines that reduce the amount of acid produced by the stomach are used to treat all forms of peptic ulcer disease.
Be careful when you take over-the-counter antacid medicines. Many of these medicines have aspirin in them. Read the label to make sure that you are not taking more than the recommended dose. Too much aspirin can be harmful.
Medicines to kill H. pyloribacteria
Doctors prescribe combination drug therapy to cure infection with H. pylori bacteria. This usually includes at least two antibiotics, a proton pump inhibitor, and sometimes a bismuth compound.
Medicines to protect the stomach
Medicines used to protect the stomach from damage caused by frequent use of aspirin or other NSAIDs include:
You can get some H2 blockers and PPIs without a prescription (over the counter or OTC). If you are using OTC acid reducers (such as Pepcid) to help with your symptoms for more than 10 to 14 days at a time, or if your symptoms are very bad, be sure to see your doctor.
Surgery is rare, but it is needed sometimes to treat:
If surgery is suggested, you may want to:
When surgery is done, it usually involves one or more of the following:
Other Works Consulted
Yang YX, et al. (2006). Long-term proton pump inhibitor therapy and risk of hip fracture. JAMA, 296(24): 2947–2953.
Current as ofMarch 27, 2018
Author: Healthwise StaffMedical Review: E. Gregory Thompson, MD - Internal MedicineAnne C. Poinier, MD - Internal MedicineAdam Husney, MD - Family MedicineJerome B. Simon, MD, FRCPC, FACP - Gastroenterology
Current as of: March 27, 2018
E. Gregory Thompson, MD - Internal Medicine & Anne C. Poinier, MD - Internal Medicine & Adam Husney, MD - Family Medicine & Jerome B. Simon, MD, FRCPC, FACP - Gastroenterology
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