What's to know about peptic ulcers?

Symptoms

Peptic ulcers may not cause any noticeable symptoms, or they may cause mild discomfort. Others may experience a dull, burning pain in their stomach.

Other symptoms can include:

• difficulty swallowing food
• nausea
• vomiting
• feeling bloated or full
• black, sticky stool (if bleeding)

In some cases, ulcers can cause severe signs and symptoms and bleeding. Signs the ulcer is bleeding include:

• vomiting blood
• black and tarry stools, or stools with dark red blood
• nausea and vomiting that is especially persistent and severe

These symptoms indicate a medical emergency. The patient should see a doctor immediately or call 911.

Causes

Peptic ulcers occur due to several potential causes, but the two most common include:

• H. pylori bacteria
• long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs)

How do H. pylori cause ulcers?

Although many people naturally carry H. pylori bacteria, it is not clear why these bacteria only cause ulcers in some people.

H. pylori spread through food and water. They live in the mucus that coats the lining of the stomach and duodenum, and they produce urease, an enzyme that neutralizes stomach acid by making it less acidic.

To compensate for this, the stomach produces more acid, and this irritates the stomach lining. The bacteria also weaken the defense system of the stomach and cause inflammation.

Patients with peptic ulcers caused by H. pylori need antibiotic treatment to remove the bacterium from the stomach and prevent them from returning.

How do nonsteroidal anti-inflammatory drugs cause ulcers?

NSAIDS are a type of medication used often for headaches, period pains, and other pains. They can also help reduce fever and inflammation. Examples include aspirin and ibuprofen. Many NSAIDs are available without a prescription.

They lower the stomach’s ability to make a protective layer of mucus. This makes it more susceptible to damage by stomach acid. NSAIDs can also affect the flow of blood to the stomach, reducing the body’s ability to repair cells.

Other causes of peptic ulcers

Other potential causes of peptic ulcers include:

• Genetics: Many individuals with peptic ulcers have close relatives with the same problem, suggesting that genetic factors may be contributing.
• Smoking: People who regularly smoke tobacco may be more likely to develop peptic ulcers when compared with non-smokers, but the exact way smoking influences peptic ulcers is unclear.
• Alcohol consumption: Drinking alcohol can irritate the stomach lining and increase acidity.
• Corticosteroid use: People on large or chronic doses of corticosteroids are also at greater risk, according to research.
• Stress: Studies regarding the increased risk of ulcers due to stress are conflicting, but one study found that psychological stress may increase the incidence of peptic ulcers in a way that cannot be explained by other factors such as NSAID use or an H. pylori infection.

Diagnosis

A person’s description of symptoms will often cause a doctor to suspect a peptic ulcer during a routine exam.

Tests that can confirm a diagnosis include:

• a blood test to check for H. pylori, though a positive test does not always mean there is an active infection
• a breath test, which uses a radioactive carbon atom to detect H. pylori
• a stool antigen test to detect H. pylori in the feces
• an upper gastrointestinal (GI) X-ray to identify ulcers

The most common tool doctors use for diagnosis is EsophagoGastroDuodenoscopy or upper endoscopy. It involves inserting a tube through the mouth to look for the presence of an ulcer in the stomach and upper intestine.

If the test detects an ulcer, the doctor may take a biopsy (a small sample of tissue) for examination under a microscope. A biopsy can test for H. pylori and look for evidence of cancer. A person may need to repeat an endoscopy a few months later to determine whether the ulcer is healing.

Treatment

Treatment will focus on either lowering stomach acid levels so that the ulcer can heal or eradicating the H. pylori infection. The following are common treatment methods a doctor may recommend:

• Antisecretory agents. These include H2 receptor antagonists and proton pump inhibitors to help block stomach acid production.
• Triple therapy. This involves using two antibiotics and a proton pump inhibitor to eradicate H. pylori.
• Avoidance of NSAIDs. Doctors recommend avoiding the use of NSAIDs if the person uses them frequently.
• Surgery. In cases of bleeding, a doctor may recommend surgical intervention, which typically requires 8-12 weeks for recovery

Diet

Dietary changes may help a person find some relief during treatment for peptic ulcers.

A person should avoid foods and flavorings that may cause the stomach to produce acids. This can vary for some people, but common causes include chili powder, garlic, black pepper, and caffeine.

Alcohol has the same effect on the stomach so a person should avoid it as well.

A person’s diet should also contain foods that provide large portions of vitamin A and fiber, which dissolves easily. These can include:

Sources of soluble fiber:

• oats
• apples
• oranges
• carrots
• psyllium husk
• legumes
• flax seeds
• nuts
• barley

Sources of vitamin A:

• liver
• broccoli
• kale
• spinach
• sweet potatoes
• collard greens

A balanced diet filled with fruits and vegetables and lacking in intense spices and flavors may help a person feel better.

However, it is important to note that diet alone cannot treat or prevent peptic ulcers so additional treatment may be necessary.

Prevention

A person may not be able to prevent all ulcers from forming.

A person can limit their use of NSAIDs to help prevent new ulcers from forming. People with chronic pain conditions should talk with their doctor about alternatives to NSAIDs that may be safer for their stomachs.

Another step to help prevent ulcers is to make sure to finish a full antibiotic regimen. A person should see their doctor for a follow-up to ensure the bacteria is under control.

Complications

Peptic ulcers can sometimes lead to complications that often require additional treatment. The three most common complications include:

• internal bleeding
• bowel obstruction
• peritonitis, which is when the ulcer bores a hole through the wall of the stomach or small intestine

Peptic ulcers can recur. Having the first ulcer increases the risk of developing another one later.

Frequently asked questions

The following sections help answer some frequently asked questions about peptic ulcers.

How common are peptic ulcers?

Peptic ulcers affect about 8% of the world population. Though they decreased in the later 20th century, they have since started to increase in frequency again in the U.S.

What is the difference between peptic ulcers, GERD, and gastritis

Peptic ulcers are holes or lesions that form due to too much acid. GERD, which stands for gastroesophageal reflux disease, occurs when a person’s stomach acid repeatedly backs up into the esophagus. Gastritis is a group of conditions that cause inflammation in the stomach. While all of these conditions affect the stomach, they are not the same and require different treatments.

Do peptic ulcers go away?

If the cause of the peptic ulcer is NSAID use, stopping the medication should help the ulcer clear. However, a bacterial infection requires treatment with antibiotics. A person should see their doctor for a proper diagnosis to determine the best course of treatment.

What foods soothe a peptic ulcer?

High-fiber foods and those high in vitamin A may help soothe a person’s stomach. Some examples include oats, barley, apples, and sweet potatoes.

Outlook

The outlook for a person with a peptic ulcer is generally good.

These ulcers can be painful and debilitating, but treatment can help the ulcer heal and alleviate the person’s symptoms.

Treating H. pylori infection and avoiding NSAIDs can help ensure that the problem does not recur.