Peptic Ulcer Disease

Topic Overview

• Peptic ulcers are sores in the inner lining of the stomach or upper small intestine. To treat peptic ulcer disease, most people need to take medicines that reduce the amount of acid in the stomach. You also may need to take antibiotics to kill an infection that can cause the disease.
• You can help speed the healing of your ulcer and prevent it from coming back if you quit smoking, limit caffeine and alcohol, and reduce stress. Continued smoking and use of medicines such as aspirin or naproxen may increase the chance of your ulcer coming back.
• Your symptoms, such as belly pain, may come and go for some time. You may have short periods free of pain. But don't ignore symptoms of an ulcer. This condition needs to be treated.
• If you are older than 45 and have a stomach ulcer, it will be tested for cancer. In rare cases, stomach ulcers contain cancer cells.

What is a peptic ulcer?

A peptic ulcer is a sore in the inner lining of the stomach or upper small intestine (duodenum). Ulcers develop when the intestine or stomach's protective outer layer is broken down. When this happens, digestive juices can damage the intestine or stomach tissue. These strong juices, which contain hydrochloric acid and an enzyme called pepsin, also can injure the esophagus. The esophagus is the tube that leads from your throat to your stomach.

Peptic ulcers are no longer a condition that most people have to live with their entire lives. Treatment cures most ulcers, and symptoms go away quickly.

Peptic ulcers that form in the stomach are called gastric ulcers. Those that form in the upper small intestine are called duodenal (say “doo-uh-DEE-nul” or “doo-AW-duh-nul”) ulcers.

See a picture of the digestive tract .

What causes peptic ulcers?

The two most common causes of peptic ulcers are:

• Infection with Helicobacter pylori (H. pylori) bacteria.
• Use of nonsteroidal anti-inflammatory drugs (NSAIDs).

H. pylori and NSAIDs break down the stomach or intestine’s protective mucus layer. The mucus layer prevents digestive juices from damaging the stomach and intestine.

What are the symptoms?

Symptoms include:

• A burning, aching, gnawing pain between the belly button (navel) and the breastbone. Some people also have back pain. The pain can last from a few minutes to a few hours and may come and go for weeks.
• Pain that usually goes away for a while after you take an antacid or acid reducer.
• Loss of appetite and weight loss.
• Bloating or nausea after eating.
• Vomiting after meals.
• Vomiting blood or material that looks like coffee grounds.
• Passing black stools that look like tar or stools that have streaks of dark red blood.

Different people have different symptoms, and some people have no symptoms at all.

How are peptic ulcers diagnosed?

Your doctor will probably ask you questions about your symptoms and your general health, and do a physical exam.

If your symptoms are not severe and you are younger than 45, your doctor may do some simple tests to look for signs of H. pylori infection.

If you are older than 45, you may need other tests, such as an endoscopy, because there is an increased chance of stomach cancer. An endoscopy is usually done by a gastroenterologist, a doctor who specializes in digestive diseases. It allows the doctor to look inside the esophagus, stomach, and intestine. During this test, your doctor may remove small pieces of tissue (biopsy) at the ulcer. This tissue may be tested for cancer. In rare cases, stomach ulcers contain cancer cells.

How are they treated?

To treat peptic ulcers, most people need to take medicines that reduce the amount of acid in the stomach. You also may need to take antibiotics to kill an H. pylori infection. Antibiotics usually help you feel better within a few days.

You can help speed the healing of your ulcer and prevent it from coming back if you quit smoking, limit caffeine and alcohol, and reduce stress. Continued use of medicines such as aspirin or naproxen may increase the chance of your ulcer coming back.

Ignoring symptoms of an ulcer is not a good idea. This condition needs to be treated. While symptoms can go away for a short time, you may still have an ulcer. Left untreated, an ulcer can cause life-threatening problems. Even with treatment, some ulcers may come back and may need more treatment.

Frequently Asked Questions

Learning about peptic ulcer disease:	What is peptic ulcer disease? What are the symptoms of peptic ulcer disease? Can I prevent peptic ulcers? What will happen if I develop a peptic ulcer? What increases my risk of developing a peptic ulcer? Who is affected by peptic ulcer disease?
Being diagnosed:	How is peptic ulcer disease diagnosed? Are there tests that can determine the cause of a peptic ulcer? Are there other conditions with symptoms similar to peptic ulcers?
Getting treatment:	How are peptic ulcers treated? When should I call a doctor? Can medications help get rid of a peptic ulcer? Is surgery an option? Are there any other treatments for peptic ulcer disease?
Ongoing concerns:	Will my peptic ulcer return? What kinds of things can I try at home?

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Author:	Colleen Cronin Ralph Poore	Last Updated: January 12, 2006
Medical Review:	Kathleen Romito, MD - Family Medicine Andrew H. Soll, MD - Gastroenterology
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