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:
Drinking too much alcohol
Regular use of aspirin, ibuprofen, naproxen, or other nonsteroidal anti-inflammatory drugs (NSAIDs). Taking aspirin or NSAIDs once in a while is safe for most people.
Smoking cigarettes or chewing tobacco
Being very ill, such as being on a breathing machine
Having radiation treatments
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:
Feeling of fullness and problems drinking as much fluid as usual
Hunger and an empty feeling in the stomach, often 1 to 3 hours after a meal
Mild nausea that may go away with vomiting
Pain or discomfort in the upper abdomen
Pain in the upper abdomen that wakes you up at night
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:
Two different antibiotics to kill H. pylori
Proton pump inhibitors such as omeprazole (Prilosec), lansoprazole (Prevacid), or esomeprazole (Nexium)
Bismuth (the main ingredient in Pepto-Bismol) may be added to help kill the bacteria
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:
Misoprostol, a drug that may help prevent ulcers in people who take NSAIDs on a regular basis
Medicines that protect the tissue lining (such as sucralfate)
If a peptic ulcer bleeds a lot, an EGD may be needed to stop the bleeding. Methods used to stop the bleeding include:
Injecting medicine in the ulcer
Applying metal clips to the ulcer
Surgery may be needed if:
Bleeding cannot be stopped with an EGD
The ulcer has caused a tear
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:
Severe blood loss
Scarring from an ulcer may make it harder for the stomach to empty
Perforation or hole of the stomach and intestines
When to Contact a Medical Professional
Get medical help right away if you:
Develop sudden, sharp abdominal pain
Have a rigid, hard abdomen that is tender to touch
Have symptoms of shock, such as fainting, excessive sweating, or confusion
Vomit blood or have blood in your stool (especially if it is maroon or dark, tarry black)
Call your health care provider if:
You feel dizzy or light-headed
You have ulcer symptoms
Avoid aspirin, ibuprofen, naproxen, and other NSAIDs. Try acetaminophen instead. If you must take such medicines, talk to your provider first. Your provider may:
Test you for H. pylori before you take these medicines
Have you take proton pump inhibitors (PPIs) or an acid blocker
Have you take a drug called misoprostol
The following lifestyle changes may help prevent peptic ulcers:
DO NOT smoke or chew tobacco.
Limit alcohol to no more than two drinks per day.
Chan FKL, Lau JYW. Peptic ulcer disease. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, PA: Elsevier Saunders; 2010:chap 53.
Chey WD, Wong BC. American College of Gastroenterology guideline on the management of Helicobacter pylori infection. Am J Gastroenterol. 2007;102:1808-25. PMID: 17608775 www.ncbi.nlm.nih.gov/pubmed/17608775.
Lanza FL, Chan FK, Quigley EM; Practice Parameters Committee of the American College of Gastroenterology. Guidelines for prevention of NSAID-related ulcer complications. Am J Gastroenterol. 2009 Mar;104(3):728-38.
Subodh K. Lal, MD, Gastroenterologist with Gastrointestinal Specialists of Georgia, Austell, GA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.