Topic Overview
What is a peptic ulcer?
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.
What causes peptic ulcers?
The two most common
causes of peptic ulcers are:
H. pylori and NSAIDs break down
the stomach or intestine's protective mucus layer.
What are the symptoms?
Symptoms include:
- A burning, aching, or gnawing pain between the
belly button (navel) and the breastbone. Some people also have back pain. The
pain can last from a few minutes to a few hours and may come and go for
weeks.
- Pain that usually goes away for a while after you take an
antacid or acid reducer.
- Loss of appetite and weight
loss.
- Bloating or nausea after eating.
-
Vomiting.
- Vomiting blood or material that looks like coffee
grounds.
- Passing black stools that look like tar, or stools that contain dark red blood.
Different people have different symptoms, and some people
have no symptoms at all.
How are peptic ulcers diagnosed?
Your doctor will
ask you questions about your symptoms and your general health, and he or she
will do a physical exam.
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.
How are they treated?
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.
Frequently Asked Questions
Learning about peptic ulcers: | |
Being diagnosed: | |
Getting treatment: | |
Ongoing concerns: | |
Cause
The two most common causes of
peptic ulcers are:
- Infection withHelicobacter pylori(H. pylori) bacteria. Although many people are infected with H. pylori
bacteria, only a few get ulcers.
- Nonsteroidal anti-inflammatory drugs (NSAIDs). When
used for weeks or months, NSAIDs can damage the lining of the digestive tract,
causing an ulcer or making an existing ulcer worse. NSAIDs include aspirin, ibuprofen, and naproxen.
A rare cause
of peptic ulcers is
Zollinger-Ellison syndrome. In this condition, the
stomach makes too much acid, damaging the stomach lining.
Although there is no evidence to prove that emotional or mental stress
causes ulcers, it does seem to make ulcers worse in some people. But the
connection is still controversial.
Symptoms
Common symptoms
Common ulcer symptoms include:
- A burning, aching pain-or a pain that feels
like hunger-between the navel and the breastbone. The pain sometimes extends to
the back.
- Belly pain that can last from a few minutes to a few
hours and that usually goes away for a while after you take an antacid or acid
reducer.
- Weeks of pain that comes and goes and may alternate with
pain-free periods.
- Loss of appetite and weight
loss.
- Bloating or nausea after eating.
Less common symptoms
Less common but more serious symptoms of ulcers
include:
- Vomiting after meals.
- Vomiting
blood and/or material that looks like coffee grounds.
- Black stools
that look like tar, or stools that contain dark red blood.
Ulcers and pains
Symptoms of ulcers in the upper small intestine (duodenal
ulcers) and in the stomach (gastric ulcers) are similar, except for when pain
occurs.
- Pain from a duodenal ulcer may occur several
hours after you eat (when the stomach is empty) and may improve after you eat.
Pain also may wake you in the middle of the night.
- Pain
from a gastric ulcer may occur shortly after you eat (when food is still in your
stomach).
Silent ulcers
Some ulcers don't cause symptoms. These are known as
silent ulcers. Silent ulcers are more common in:
Symptoms in children
In children, symptoms vary with age:
- Toddlers and young children may complain of
general stomach pain.
- Teenagers may have symptoms more like those
of adults.
The symptoms of an ulcer often can be confused with
other abdominal conditions, such as
dyspepsia or
gastroesophageal reflux disease (GERD).
What Happens
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
nonsteroidal 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
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).
What Increases Your Risk
Risk factors you can control
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.
Risk factors you cannot control
Some things that
you cannot control may increase your risk of getting an ulcer. These
include:
- A
Helicobacter pylori (H. pylori) infection, the most common cause of
ulcers.
- Physical stress caused by a serious illness or injury (such
as a major trauma, surgery, or the need to be on a ventilator to assist breathing).
- Hypersecretory condition, in which your stomach produces too much acid.
- A personal or family
history of ulcers.
When To Call a Doctor
If you have been diagnosed with
a
peptic ulcer, call 911 or other emergency services immediately if you have:
- Symptoms that could indicate a
heart attack or
shock.
- Sudden severe, continuous belly
pain or vomiting.
Call your doctor or seek medical attention right away if you have:
- Frequent feelings of dizziness or
lightheadedness, especially when moving from lying down to a seated or standing
position.
- Blood in your vomit or something that looks like coffee grounds
(partially digested blood) in your vomit.
- Stools that are black or
that look like tar, or stools that contain dark red or maroon blood.
Call your doctor if you have been diagnosed with a peptic
ulcer and:
- Your symptoms continue or become worse after 10
to 14 days of treatment.
- You begin to lose weight without
trying.
- You are vomiting.
- You have new belly pain or
belly pain that does not go away.
Watchful waiting
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 nonprescription acid reducer and other home
treatment, such as making changes to your diet.
- If your symptoms don't get better after 10 to
14 days, call your doctor.
- If your symptoms go away after you take
antacids or acid reducers and try home treatment, but then the symptoms come
back, call your doctor.
Who to see
To evaluate your symptoms, see your:
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.
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Exams and Tests
Although not all peptic ulcers are caused by bacteria, it's getting more common to do a test for Helicobacter 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:
- Look at the inside of your stomach and your upper small intestine to
check for an ulcer.
- Collect a tissue sample
(biopsy) that can be tested for H. pylori or cancer.
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:
- Ulcer symptoms for the first
time.
- Ulcer symptoms that return before or after treatment is
completed.
- A family history of stomach
cancer.
- Other symptoms that may point to a more serious
problem, such as stomach cancer. These include:
- Blood in the stool.
- Weight loss
of more than 10% of body weight.
- Difficulty swallowing
(dysphagia).
- Jaundice.
- Abdominal mass.
Other tests that may be done include:
- Fecal occult blood test (FOBT). This test may be done to detect
blood in the stool, which may be caused by a peptic ulcer or another serious
problem, such as colon cancer. By itself, an FOBT cannot diagnose peptic ulcer
disease, but it may show if an ulcer is bleeding.
- Complete blood count (CBC). This blood test may be done to look
for anemia, which may be caused by a bleeding ulcer.
- Upper GI series. This X-ray
exam of the esophagus and stomach may be used to diagnose peptic ulcer disease, although this test
is being used less frequently.
Treatment Overview
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:
- Not taking nonsteroidal anti-inflammatory drugs (NSAIDs), if possible. These include aspirin, ibuprofen (such as Advil), and naproxen (such as Aleve).
- Quitting smoking.
- Not drinking too
much alcohol (no more than 2 drinks
a day for men and 1 drink a day for women).
H. pylori
infection
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).
Treatment if ulcers get worse
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.
Prevention
You can greatly reduce the chance that you
will get a
peptic ulcer if you:
- Don't smoke. Smokers
are much more likely than nonsmokers to get ulcers. For ways to quit
smoking, see the topic
Quitting Smoking.
- Avoid NSAIDs. Avoid taking
aspirin, ibuprofen, and other
nonsteroidal anti-inflammatory drugs (NSAIDs) for
longer than a few days at a time. If you are taking one of these medicines daily, for example taking aspirin for heart
problems, ask your doctor about taking medicine to help protect your
stomach and intestines from ulcers.
- Drink alcohol only in moderation. Limit
alcohol to 2 drinks a day for men and 1 drink a day for women.
Home Treatment
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:
- Stop smoking.
- Try nonprescription medicines that reduce stomach acid. Make sure you
tell your doctor about any medicines you are taking.
- Make changes to your diet, such as eating smaller, more frequent meals. (These
changes may improve your symptoms, but they won't help your ulcer
heal.)
- Drink alcohol only in moderation, or not at all. Limit alcohol to 2 drinks a day for men and 1 drink a day for women. Drinking
too much alcohol may make an ulcer heal more slowly and may make your symptoms
worse.
Medications
Medicines are used to:
- Treat peptic ulcers by reducing the amount of acid
produced by the stomach.
- Kill Helicobacter pylori (H. pylori)
bacteria if they are infecting the stomach
lining.
- Protect the lining of the stomach and upper small intestine from injury caused by nonsteroidal anti-inflammatory drugs (NSAIDs). These include aspirin, ibuprofen (such as Advil), and naproxen (such as Aleve).
Medicine choices
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.
- Antacids (such as Tums)
- Acid reducers
- H2 blockers (such as Zantac). Some H2 blockers are available without a prescription.
- Proton pump inhibitors (PPIs) (such as Prilosec). Some PPIs are available without a prescription.
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. pylori
bacteria
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:
- Acid reducers. These include:
- H2 blockers (such as Zantac).
- Proton pump inhibitors (PPIs) (such as Prilosec).
- Prostaglandin analogs (such as Cytotec).
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 Prilosec or 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
Surgery is rare, but it is needed sometimes to treat:
- Ulcers that don't heal (intractable peptic ulcers).
- Life-threatening
complications of an ulcer, such as severe bleeding,
perforation, or obstruction.
If surgery is suggested, you
may want to:
- Seek a second opinion and ask whether all
medicine treatment options have been tried.
- Compare the cost of
long-term medicine treatment to the one-time cost of
surgery.
- Remember that no surgery can completely prevent ulcers
from returning.
- Find a surgeon who has a lot of experience with
surgery for ulcers.
Surgery choices
When surgery is done, it usually
involves one or more of the following:
- Cutting one or more of the nerves to the
stomach (vagotomy).
- Widening the opening of the bottom of the
stomach (pyloroplasty).
- Removing part of the stomach (partial
gastrectomy).
Other Places To Get Help
Organization
National Institute of Diabetes and Digestive and Kidney Diseases (U.S.)
www.digestive.niddk.nih.gov
References
Other Works Consulted
- Yang YX, et al. (2006). Long-term proton pump inhibitor therapy and risk of hip fracture. JAMA, 296(24): 2947-2953.
Credits
ByHealthwise Staff
Primary Medical ReviewerE. Gregory Thompson, MD - Internal Medicine
Adam Husney, MD - Family Medicine
Specialist Medical ReviewerAdam Husney, MD - Family Medicine