Peptic Ulcer

Causes

Acids that help you 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, or burns

Risk Factors

Factors that may increase 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 awaken you from sleep
  • Is worse on an empty stomach
  • Can be relieved 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 your symptoms and past health. A physical exam will be done. The doctor may suspect an ulcer based on your symptoms.

An endoscopy will help to 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—sample of tissue is removed to look for cause

Treatment

Treatment will depend on the cause. General steps include:

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

Medicine

Stomach acid can be managed with:

• Proton pump inhibitors (PPI)—decrease production of acid
• H2 blockers—if PPIs aren't effective
• 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 to stop small areas of bleeding.

Surgery may be needed for:

• An ulcer that won't heal
• Ulcers that return often
• Severe bleeding
• A perforation—sore has passed all the way through stomach wall (emergency surgery)
• Problems passing food out of the stomach

There are different types of surgery. Options include:

• Removal of the ulcer
• Removal of part of the stomach or small intestine
• Tying off the bleeding blood vessel
• A section of healthy tissue is removed and sewn over the ulcer
• Cut nerve that is linked to acid production

Prevention

To help reduce the chances of H. pylori infection:

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

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

• Use other drugs when possible for managing 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.