A peptic ulcer is an open sore or raw area in the lining of the stomach or intestine.
Ulcer – peptic; Ulcer – duodenal; Ulcer – gastric; Duodenal ulcer; Gastric ulcer; Dyspepsia – ulcers; Bleeding ulcer; Gastrointestinal bleeding – peptic ulcer; Gastrointestinal hemorrhage – peptic ulcer; G.I. bleed – peptic ulcer; H. pylori – peptic ulcer; Helicobacter pylori – peptic ulcer
Normally, the lining of the stomach and small intestines can protect itself against strong stomach acids. But if the lining breaks down, the result may be:
Most ulcers occur in the first layer of the inner lining. A hole that goes all the way through the stomach or duodenum is called a perforation. A perforation is a medical emergency.
The most common cause of ulcers is infection of the stomach by bacteria called Helicobacter pylori (H pylori). Most people with peptic ulcers have these bacteria living in their digestive tract. Yet, many people who have these bacteria in their stomach do not develop an ulcer.
The following factors raise your risk for peptic ulcers:
A rare condition called Zollinger-Ellison syndrome causes stomach and duodenal ulcers.
Many people believe that stress causes ulcers. It is not clear if this is true for normal stress.
Small ulcers may not cause any symptoms. Some ulcers can cause serious bleeding.
Abdominal pain is a common symptom. The pain can differ from person to person, and some people have no pain.
Other symptoms include:
Other possible symptoms include:
Exams and Tests
To diagnose an ulcer, you may need a test called an upper endoscopy (EGD).
Upper endoscopy is done on most people when peptic ulcers are suspected or when you:
Testing for H. pylori is also needed.
Other tests you may have include:
Sometimes, you may need a test called an upper GI series. A series of x-rays are taken after you drink a thick substance called barium. This does not require sedation.
In order for your ulcer to heal and to reduce the chance it will come back, you will be given medicines to:
Take all of your medicines as you have been told. Other changes in your lifestyle can also help.
If you have a peptic ulcer with an H pylori infection, the standard treatment uses different combinations of the following medicines for 7 to 14 days:
If you have an ulcer without an H pylori infection, or one that is caused by taking aspirin or NSAIDs, you will likely need to take a proton pump inhibitor for 8 weeks.
You may also be prescribed this type of medicine regularly if you must continue taking aspirin or NSAIDs for other health conditions.
Other medicines used for ulcers are:
If a peptic ulcer bleeds a lot, an EGD may be needed to stop the bleeding. Methods used to stop the bleeding include:
Surgery may be needed if:
Peptic ulcers tend to come back if untreated. There is a good chance that the H pylori infection will be cured if you take your medicines and follow your health care provider’s treatment advice. You will be much less likely to get another ulcer.
Complications may include:
When to Contact a Medical Professional
Get medical help right away if you:
Call your provider if:
Avoid aspirin, ibuprofen, naproxen, and other NSAIDs. Try acetaminophen instead. If you must take such medicines, talk to your provider first. Your provider may:
The following lifestyle changes may help prevent peptic ulcers:
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Laine L, Jensen DM. Management of patients with ulcer bleeding. Am J Gastroenterol. 2012;107(3):345-360. PMID: 22310222 www.ncbi.nlm.nih.gov/pubmed/22310222.
Morgan DR, Crowe SE. Helicobacter pylori infection. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran’s Gastrointestinal and Liver Disease. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 51.