Peptic Ulcer

Causes

Acids that help break down food can lead to an ulcer. A change to the amount of acid causes damage to the stomach or intestine walls. This is most often caused by:

• Helicobacter pylori (H. pylori) infection
• Nonsteroidal anti-inflammatory drugs (NSAIDs)

Less common causes include:

• Zollinger-Ellison syndrome
• Tumors
• Crohn disease
• Bacterial or viral infections of the stomach
• Damage from radiation therapy
• Severe stress such as:
  • Surgery
  • Trauma
  • Head injury
  • Shock
  • Burns

Risk Factors

Things that may raise the chances of a peptic ulcer include:

• Taking NSAIDs for a long time and at higher doses
• Prior peptic ulcer disease
• Cigarette smoking
• Alcohol use disorder
• Spicy food
• Untreated stress

Symptoms

Peptic ulcers do not always cause symptoms. Symptoms may come and go. Food or fluids may make symptoms better and an empty stomach may make them worse.

Symptoms may include:

• Burning stomach pain that:
  • May make a person wake up from sleep
  • Is worse on an empty stomach
  • Can be eased with food or antacids
• Feeling of fullness
• Bloating
• Nausea
• Vomiting
• Burping
• Loss of appetite
• Heartburn

Ulcers can cause bleeding. It is rare, but heavier bleeding can cause:

• Bloody or black, tarry stools
• Vomiting what looks like coffee grounds or blood

Diagnosis

The doctor will ask about symptoms and past health. A physical exam will be done. The doctor may suspect an ulcer based on symptoms.

An endoscopy will help make the diagnosis. A scope will be passed down the throat to view the lining of the stomach.

Other tests may include:

• H. pylori test—may be done through blood, stool, or a breath test
• Biopsy—a sample of tissue is removed to look for cause

Treatment

The goals of treatment are:

• Stopping further damage by decreasing stomach acid
• Allowing time for the ulcer to heal

How this is done depends on what is causing the ulcer.

Medicine

Stomach acid can be managed with:

• Proton pump inhibitors (PPI)—these reduce the amount of acid made
• H2 blockers—if PPIs are not working
• Over the counter antacids—neutralizes stomach acid

Medicine related to causes include:

• Stop or limit NSAIDS—doctor may switch to another medicine if needed
• Antibiotics to treat H. pylori infection

Quit smoking. Smoking worsens symptoms and slows healing.

Surgery and Endoscopy

An endoscopy may help stop small areas of bleeding.

Surgery may be needed for:

• An ulcer that will not heal
• Ulcers that come back often
• Severe bleeding
• A sore that has passed all the way through stomach wall called a perforation—this is an emergency and needs surgery right away
• Problems passing food out of the stomach

There are different types of surgery. Options include:

• Removing the ulcer
• Removing part of the stomach or small intestine
• Tying off the bleeding blood vessel
• Taking a section of healthy tissue and sewing it over the ulcer
• Cutting a nerve that is linked to acid production

Prevention

To help reduce the chances of H. pylori infection:

• Wash your hands often. This is key after using the bathroom and before eating or making food.
• Drink water from a safe source.
• Do not smoke. Smoking raises the chances of getting an ulcer.

To help reduce the chances of a peptic ulcer from NSAIDs:

• Use other drugs when possible to manage pain.
• Take the lowest possible dose.
• Do not take drugs longer than needed.
• Do not drink alcohol while taking the drugs.
• Do not smoke. Smoking increases the chances of getting an ulcer.