Peptic Ulcers (Stomach Ulcers) – an Overview | Gastroenterology

Peptic Ulcers (Stomach Ulcers)

What are peptic ulcers (stomach ulcers)?

Peptic ulcers are open sores that appear on the inner lining of your stomach and the upper part of the small intestine. The most widely recognized indication of a peptic ulcer is stomach pain.

Includes peptic ulcers:

  • Gastric ulcers that occur inside the stomach
  • Duodenal ulcers that occur in the inner part of the upper part of the small intestine (the duodenum)

The most common causes of peptic ulcers are infection with Helicobacter pylori (H. pylori) bacteria and long-term use of non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve). Stress and fiery nourishments don’t cause peptic ulcers. However, symptoms can worsen.

Causes of peptic ulcers

Various factors can cause the lining of the stomach, esophagus, and small intestine to collapse. These include:

  • Helicobacter pylori (H. pylori), a type of bacteria that can cause inflammation and inflammation in the stomach
  • Frequent use of aspirin (Bayer), ibuprofen (Advil), and other anti-inflammatory drugs (risks associated with this behaviour increase in women and people over 60)
  • Smoking
  • Radiation therapy
  • Drinking too much alcohol
  • Stomach cancer

What are the symptoms of peptic ulcers?

A mild or burning pain in your stomach is the most common symptom of a peptic ulcer. You may feel the pain anywhere between the navel and the breastbone. Pain most often

  • It occurs when your stomach is empty – such as between meals or at night
  • Pause briefly if you eat or if you take antacids
  • It lasts from minutes to hours
  • It comes and goes for days, weeks, or months

Less common symptoms may include

  • Bloating
  • Feeling sick to your stomach
  • Vomiting
  • Poor appetite
  • Burping
  • Weight loss

Regardless of whether your side effects are mellow, you may have a peptic ulcer. You should see your PCP to discuss your side effects. Without treatment, peptic ulcers can get worse.

Peptic ulcers treatment

The type of treatment usually depends on the cause of the peptic ulcer. Treatment will either focus on lowering stomach acid levels so that the ulcers can heal, or eliminating the H.pylori infection.

  • Proton pump inhibitors (PPIs): Proton siphon inhibitors diminish the measure of corrosive your stomach produces. They are prescribed to patients who have tested positive for H.pylori. Treatment usually lasts one to two months, but if the ulcer is severe, treatment may last longer.
  • H. pylori infection treatment: Patients with H.pylori usually need proton pump inhibitors and antibiotics. This treatment is effective in most patients, and the sore will start to disappear within days. Upon completion of treatment, the individual should be tested again to ensure that the H.pylori bacteria are gone. If needed, they will undergo another course of various antibiotics.
  • Non-steroidal anti-inflammatory drugs: If the ulcer was caused by an NSAID, the patient will have to stop taking it. Alternatives include acetaminophen. If a person cannot stop taking NSAIDs, the doctor may reduce the dose and review the patient’s need for it later. Another long-term medication may be prescribed along with an NSAID.
  • Follow-up treatment: Even after the ulcer has healed and treatment is completed, the patient may still have indigestion. In such cases, the doctor may recommend some diet and lifestyle changes. If symptoms persist, a low-dose proton pump inhibitor or H2 receptor antagonist may be prescribed. In severe cases with bleeding, an endoscopy may be needed to stop bleeding at the site of the ulcer.

Complications of peptic ulcers

Most peptic ulcers can be treated without complications. However, in some cases, peptic ulcers can develop into potentially life-threatening complications, such as:

  • Bleeding (hemorrhage)
  • Penetration
  • Perforation
  • Obstruction (blockage)
  • Cancer


Bleeding (hemorrhage) is the most common complication of an ulcer even when it is not painful (see Gastrointestinal Bleeding). Vomiting of bright red blood or reddish-brown lumps of partially digested blood that look like ground coffee (haematemesis) and pass black tarry stools (melena) or clear, bloody stools (hematechesia) can be symptoms of hemorrhagic ulcers. Blood loss may also lead to weakness, low blood pressure upon standing, sweating, thirst, and fainting. However, small amounts of blood in the stool may not be noticeable, but if they persist, they may lead to anemia.

Bleeding may result from other conditions in the digestive system as well, but doctors begin their investigation by looking for the source of the bleeding in the stomach and duodenum. Unless the bleeding is severe, the doctor uses a flexible viewing tube (endoscope) to perform an upper endoscopy. If a bleeding sore appears, an endoscope can be used to cauterize it (i.e. stop the bleeding with heat). The doctor may also use an endoscope to inject a substance that causes the bleeding ulcer to clot.

If the source cannot be found and the bleeding is not severe, treatments include medications that suppress acid production, such as histamine 2 (H2) blockers or proton pump inhibitors. A person also receives fluids intravenously and takes nothing by mouth, so the digestive system can relax. If these procedures fail, surgery is required.


The ulcer can pass (penetrate) the muscular wall of the stomach or duodenum (the first part of the small intestine) and continue to a nearby organ, such as the liver or pancreas. This penetration causes intense, burning, and persistent pain that can be felt in an area of the body other than the affected area. For example, the back may hurt when a duodenal ulcer invades the pancreas. The pain may increase when a person changes position.

Doctors use imaging tests such as computerized tomography (CT) and magnetic resonance imaging (MRI) to diagnose breakouts. If medications do not cure the ulcer, surgery may be required.


Ulcers on the front surface of the duodenum, or less commonly in the stomach, can pass through the wall, creating an opening (perforation) in the empty space in the abdominal cavity. The resulting pain is sudden, intense, and persistent. The pain quickly spreads throughout the abdomen. A person may feel pain in one or both shoulders. Breathing deeply and changing position exacerbates the pain, so the person often tries to lie still. The abdomen becomes tender to the touch, and the pain gets worse if the doctor presses deeply and then suddenly releases the pressure. (Doctors call this rebound tenderness.)

Symptoms of perforation may be less severe in the elderly, in people who are taking corticosteroids or immunosuppressants, or in severely ill patients. Fever indicates an infection in the abdominal cavity. If the condition is not treated, shock may occur. Doctors do an X-ray or CT scan to help with the diagnosis. This emergency condition (called acute abdomen) requires immediate surgery and intravenous administration of antibiotics.


Swelling of inflamed tissue around an ulcer or scarring from a previous ulcer flare-up can lead to a narrowing of the gastric outlet or narrowing of the duodenum. A person with this type of obstruction may vomit frequently – often resulting in vomiting large amounts of food that were eaten hours earlier. Symptoms of obstruction include feeling unusually full after eating, bloating, and decreased appetite. Over time, vomiting can cause weight loss, dehydration, and an imbalance of body chemicals (electrolytes).

Doctors base the diagnosis of blockage on the results of an X-ray. Treating ulcers and swelling relieves obstruction in most cases, but severe blockages caused by scarring may require an endoscopic dilation or surgery.


People with ulcers caused by the H.pylori bacterium are 3 to 6 times more likely to develop stomach cancer later in life. There is no increased risk of developing cancer from ulcers that have other causes.

Risk factors for peptic ulcers

In addition to having risks associated with taking NSAIDs, you may be at greater risk of developing peptic ulcers if you:

  • Smoking may increase the risk of developing peptic ulcers in people infected with H. pylori.
  • Drink alcohol: Liquor can disturb and disintegrate the mucous covering of your stomach and expands the measure of stomach corrosive that is delivered.
  • Have untreated stress
  • Eat spicy foods

These factors alone do not cause ulcers, but they may make ulcers worse and more difficult to heal.

What procedures and tests diagnose peptic ulcers?

Ulcers are diagnosed by either barium x-ray of the upper gastrointestinal tract (upper GI series) or upper gastrointestinal endoscopy (EGD or endoscopy of the esophagus, stomach, and intestine). An upper gastrointestinal (GI) barium X-ray is easy to perform and poses no risks (other than radiation exposure) or discomfort. Barium is a chalky substance that is swallowed. It can be seen on X-rays and allows the stomach diagram to be seen with X-rays; However, barium X-rays are less accurate and ulcers may be lost up to 20% of the time.

An upper gastrointestinal endoscopy is more accurate than an X-ray, but it usually involves sedation of the patient and the insertion of a flexible tube through the mouth to examine the esophagus, stomach, and duodenum. Upper endoscopy has the added advantage of having the ability to remove small tissue samples (biopsies) to test for H. pylori infection. Biopsies are also examined under a microscope to rule out cancerous ulcers. While all duodenal ulcers are benign, stomach ulcers can sometimes be precancerous. Therefore, biopsies are often performed on stomach ulcers to rule out cancer.

How can I prevent peptic ulcers?

You may be able to prevent peptic ulcers from forming if you are:

  • Talk to your doctor about alternatives to non-steroidal anti-inflammatory drugs (such as acetaminophen) for pain relief
  • Discuss preventive measures with your doctor, if you cannot stop taking NSAIDs
  • Choose the lowest effective dose of NSAIDs and take it with a meal
  • Quit Smoking
  • Drink alcohol in moderation, if you do

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