Peptic Ulcers

By:    Medically Reviewed: Tom Iarocci, MD   Published: July 31, 2013

It’s difficult to diagnose a peptic ulcer because symptoms vary, but it usually starts with a burning sensation that travels north from the navel to the breast bone.

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Peptic ulcers are sores, or raw areas, that develop in the lining of the duodenum the first part of the small intestine.

Ulcers in the stomach are more commonly referred to as gastric ulcers, but both types can be confused with symptoms of a heart attack, especially when pain radiates to the back or the chest.

Peptic ulcers can cause a variety of symptoms and may occasionally occur without any symptoms at all. The pain or discomfort from an ulcer can reflect its location in the stomach or small intestine, however.  In rare cases, ulcers form on the esophagus as well, according to The National Institutes of Health.

  • If the ulcer is in your stomach, it likely occurs between meals or at night (before bedtime) when your stomach is empty. Eating will makes this type of ulcer more uncomfortable.
  • If the ulcer is in your duodenum, the pain may be felt several hours after a meal. In the worst-case scenario, peptic ulcers can erode through a blood vessel, which may cause life-threatening bleeding. Internal bleeding may occur if you’ve seen blood in your vomit or black, tarry stools.

Other symptoms of peptic ulcers may include:

  • Feeling very full
  • Weight loss
  • Bloating
  • Vomiting
  • Burping
  • Mild nausea or a hunger-like burning

Common causes of peptic ulcers

Prior to recent research, many people thought you could create an ulcer by eating spicy foods or dealing with an abundance of stress. While excessive alcohol, smoking, stress and hot foods can exacerbate pain and symptoms of a peptic ulcer, they cannot cause them. 

Rather, two things directly cause a peptic ulcer:

  • An inflammatory, bacterial infection referred to as Helicobacterium pylori (or H. pylori): Corkscrew-shaped bacteria are present in the lining of the stomach and duodenum in ulcer sufferers. The bacterial infection causes damage to the lining of the stomach and small intestine, which triggers the development of ulcers.
  • Long-term use of non-steroidal anti-inflammatory drugs (NSAIDS): Often taken to treat inflammatory conditions such as arthritis and headache, common over the counter NSAIDs include aspirin, ibuprofen (Motrin) or naproxen (Aleve, Naprosyn).

Antacids may offer some relief, regardless of the location of the ulcer, but only antibiotics can zap the bacterial infection. Not everybody who has symptoms has an ulcer, and not everyone who has an ulcer has a peptic ulcer, so it’s important to discuss your symptoms with a healthcare provider.

If you or a loved one has been diagnosed with an NSAID-caused ulcer, stop taking NSAIDs immediately and talk to your doctor about pain-relief alternatives. The overall goal in treating peptic ulcers is to kill the H. pylori bacterium and/or to reduce the level of acid to relieve pain and encourage healing.

What are your next steps?

Your healthcare provider will typically order one or more tests: 

Test for H. pylori. A blood test, a stool test and a breath test are all available to test for its presence.   

Upper GI: The barium upper gastro-intestinal (GI) X-ray series involved drinking a barium-based liquid (sometimes called a barium swallow or an upper GI series) to make ulcers hyper-visible. It’s simple and painless.

Lower GI. This endoscopy procedure involves insertion of a flexible tube (with a tiny camera) down the esophagus and stomach, and out to the duodenum. The endoscopist can see signs of disease, including inflammation, bleeding, ulcers or masses. If an ulcer is found, a small tissue sample (biopsy) can be taken for testing and to exclude other causes of the ulcer, such as malignancy.

Diet. Interestingly, contrary to popular opinion, drinking milk does not help peptic ulcers heal or minimize symptoms by coating the throat and stomach. According to experts at the Mayo Clinic, drinking any glass of dairy may make ulcers feel better momentarily, but it also increases stomach acid; too much stomach acid makes ulcers worse.

Antibiotics. A course of antibiotics and a proton pump inhibitor is commonly used to treat the infection. Commonly prescribed antibiotics for the treatment of H. pylori include clarithromycin, metronidazole or amoxicillin.  

Acid (H-2) blockers. These medications decrease the amount of acid released into your digestive tract, and they are available by prescription or over-the-counter, including ranitidine (Zantac) and famotidine (Pepcid).

Antacids. Antacids neutralize existing stomach acid and provide rapid pain relief. They are usually provided in conjunction with other treatments. Common antacids include Tums, Rolaids and Maalox. 

Surgery is rarely needed for peptic ulcers. Your doctor may prescribe a round of antibiotics to knock out the H. pylori bacterial infection. Also, if you are a regular smoker, quit now to sidestep the harsh symptoms of a peptic ulcer. You also should avoid alcohol. Smoking and drinking regularly can slow the healing of ulcers and increase your discomfort. 

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sources
  • National Institutes of Health. “Peptic ulcer.” MedlinePlus. www.nlm.nih.gov. Accessed May 2013.
  • Milosavljevic T, Kostic-Milosavljevic M, Jovanovic I, Krstic M. “Complications of peptic ulcer disease.” Dig Dis (Basel, Switzerland). 2011;29(5):491-493. www.ncbi.nlm.nih.gov. Accessed July 2013.
  • National Digestive Diseases Information Clearinghouse. “H. pylori and peptic ulcers.” digestive.niddk.nih.gov. Accessed May 2013.
  • Ramakrishnan K, Salinas RC. “Peptic ulcer disease.” Am Fam Physician. 2007;76(7):1005-1012. www.ncbi.nlm.nih.gov. Accessed May 2013.
  • Shiota S, Nguyen LT, Murakami K, et al. “Association of helicobacter pylori dupA with the failure of primary eradication.” J Clin Gastroenterol. 2012;46(4):297-301. www.ncbi.nlm.nih.gov. Accessed May 2013.
  • University of Maryland Medical Center. “Peptic ulcers – symptoms.” www.umm.edu. Accessed May 2013.