Peptic Ulcers

Peptic ulcers are open sores that develop on the inner lining of the stomach or the duodenum (the first part of the small intestine). These ulcers can cause discomfort, indigestion, bloating and other digestive issues. 

Peptic ulcers can often be treated with medication and lifestyle changes. They may lead to serious complications like bleeding or blockages in your digestive system if they aren’t treated.

Understanding the causes, symptoms and treatment options for peptic ulcers can help you manage them and improve your quality of life.

What are peptic ulcers?

There are two main types of peptic ulcers:

• Gastric ulcers, also called stomach ulcers, occur when acids erode the stomach’s protective lining.
• Duodenal ulcers develop in the first part of the small intestine.

Both types of ulcers are part of a condition called peptic ulcer disease. Stomach acids contribute to these ulcers, since they may damage the stomach lining and make the digestive tract more likely to become irritated and infected. 

Causes and risk factors for developing peptic ulcers

The main causes of peptic ulcers are Helicobacter pylori (H. pylori) infection and NSAID use:

H. pylori infection

H. pylori bacteria are one of the most common causes of peptic ulcers. They damage the stomach lining and the protective barrier against stomach acids, making it easier for ulcers to form.

You could be infected with H. pylori if you consume contaminated food or water or if you’re in close contact with someone who is infected. The infection is common but not everyone who is infected develops ulcers.

Nonsteroidal anti-inflammatory drugs (NSAIDs)

You may take NSAIDs like aspirin, ibuprofen (Advil, Motrin) or naproxen (Aleve) for pain or fever relief. They’re common and effective. But in the long term, NSAIDs can irritate and inflame your stomach lining and increase your risk of ulcers. That’s because these medications cause your stomach lining to produce less of a substance that protects it. 

Anyone can get peptic ulcers from NSAIDs. Your risk is higher if you:

• Are age 60 or older
• Are female
• Have had a peptic ulcer before
• Are infected with H. pylori
• Take high doses of NSAIDs or more than one type of NSAID
• Have two or more medical conditions or diseases
• Are taking other medicines, such as corticosteroids like prednisone or medicines to increase your bone mass
• Drink alcohol or smoke

If you take NSAIDs, use them only as directed and talk to your health care provider if you need to take them over a long period.

Other causes

A few other factors are linked with peptic ulcers:

• Infections from germs other than H. pylori
• Stomach or duodenum surgery or diseases
• Lifestyle factors like smoking, drinking a lot of alcohol and unmanaged stress levels 
• A family history of peptic ulcers 
• Uncommon conditions such as Zollinger-Ellison syndrome 

Signs and symptoms of peptic ulcers

Common symptoms of peptic ulcers include:

• Stomach pain: You may feel a burning or gnawing sensation in your upper abdomen (belly), between your belly button and breastbone. It may be worse when your stomach is empty or at night. It may come and go.
• Indigestion: You may feel full, bloated or uncomfortable after you eat.
• Loss of appetite: The discomfort may mean you don’t feel like eating.
• Bloating or belching: You may have gas in your digestive system.
• Nausea or vomiting: These symptoms are more common if the ulcer is severe.

If you have any of these symptoms, contact your health care provider. Untreated, peptic ulcers can lead to more serious symptoms such as:

• Vomiting blood, or vomit that looks like coffee grounds: This may be a sign of internal bleeding (bleeding inside your body).
• Black, tarry stools: This may also be a sign of internal bleeding.
• Unexplained weight loss: This may be a sign that the ulcer is blocking your digestive tract.

If you have any of these serious symptoms, get medical care right away. Internal bleeding and digestive tract blockages are medical emergencies.

Diagnosis of peptic ulcers

To diagnose peptic ulcers, your health care provider will ask you about your symptoms and your medical and family history. They will want to know what medications you take, especially NSAIDs, and whether you’ve had peptic ulcers before. They will perform a physical exam, checking your abdomen for pain, swelling or abnormal sounds.

They may order these tests:

• Upper GI endoscopy: With an upper GI (gastrointestinal) endoscopy, your provider passes a thin, flexible tube with a camera into the stomach and duodenum. With this test, your provider can see the ulcer and take biopsies (tissue samples) for testing.
• Testing for H. pylori: Breath, stool or blood tests can show if you have an H. pylori infection. 
• Blood test: A blood test can check for anemia, which could be caused by bleeding ulcers.
• Other tests: In some cases, your provider may use imaging tests like X-rays or barium swallow tests to get a better view of the digestive tract.

Treatment options for peptic ulcers

Peptic ulcer treatment depends on what’s causing the ulcer and how severe it is. Your provider may recommend medications such as:

• Proton pump inhibitors (PPIs): Medications like omeprazole reduce the amount of acid your stomach produces, so the ulcer can heal. 
• Antibiotics: If an H. pylori infection is causing the ulcer, antibiotics can help.
• H2 blockers: Like PPIs, these medications reduce stomach acid so the ulcer can heal.
• Antacids: Over-the-counter (OTC) antacids can neutralize stomach acid and help relieve symptoms.

Lifestyle changes may help as well. Your provider may recommend avoiding alcohol, smoking and spicy foods, since they can make ulcers worse. Reducing stress and eating smaller, more frequent meals may also help.

Most of the time, ulcers get better with medication and lifestyle changes. In rare cases, if these treatments don’t work or you have complications like severe bleeding or perforation (a hole in your stomach or duodenum), you may need surgery.

Gastric ulcers, unlike duodenal ulcers, usually require a longer treatment period and a second look endoscopy due to the small chance that they may be associated with cancer.  Biopsies are obtained during the second look endoscopy to ensure that they are benign.  Otherwise, more prolonged care may be needed.

Preventing peptic ulcers

These lifestyle changes may help you prevent peptic ulcers:

• Limit NSAIDs: Use these medications only as prescribed and for as little time as possible.
• Quit smoking: Smoking can make it harder for ulcers to heal and more likely they will come back.
• Limit alcohol: Alcohol can irritate the stomach lining and make your stomach produce more acid.
• Practice good hygiene: Prevent H. pylori infection by washing your hands often and preparing food according to safe practices.

Living with peptic ulcers

Peptic ulcers can be painful but the right treatment can clear up your symptoms. It's important to follow your treatment plan, take your medications as directed and avoid triggers like NSAIDs, alcohol and smoking. See your health care provider for follow-up appointments to make sure the ulcer heals properly and to lower the risk that you’ll develop another one.

Why choose Banner Health for peptic ulcer treatment?

At Banner Health, our specialists are experts in managing and treating gastric and duodenal ulcers. We offer advanced diagnostic tools, such as upper GI endoscopy, and our comprehensive treatment plans are designed to address the root cause of your ulcer.

If you suspect you have a peptic ulcer or you would like more information, schedule an appointment with a Banner Health gastroenterologist. With early diagnosis and treatment, you can manage peptic ulcers and lower your risk of complications.