- Stomach ulcer
- Symptoms & Causes of Peptic Ulcers (Stomach Ulcers) | NIDDK
- What causes a peptic ulcer?
- How do NSAIDs cause a peptic ulcer?
- How do H. pylori cause a peptic ulcer and peptic ulcer disease?
- How do tumors from ZES cause peptic ulcers?
- When should you call or see a doctor?
- Peptic Ulcers (Stomach Ulcers)
- Peptic ulcers: Symptoms, causes, and treatments
- Proton pump inhibitors (PPIs)
- H. pylori infection treatment
- Non-steroidal anti-inflammatory drugs
- Follow-up treatment
- How does H. pylori cause ulcers?
- How do non-steroidal anti-inflammatory drugs cause ulcers?
- Other causes of peptic ulcers
- Stomach ulcer (Gastric ulcer)
- Treating Helicobacter pylori (H. pylori) infection
- Side effects
- Further testing
- Ulcers caused by NSAIDs
- Alternative painkillers
- Low-dose aspirin
- H2-receptor antagonists
- Antacids and alginates
- Lifestyle changes
- Stomach ulcers: Causes, symptoms, and treatment
- Risk factors
- NSAID drugs and stomach ulcers
- Surgical treatments
- Peptic Ulcer: Causes, Treatment, and Prevention
- Upper endoscopy
- Upper GI
Stomach ulcers, also known as gastric ulcers, are open sores that develop on the lining of the stomach.
Ulcers can also occur in part of the intestine just beyond the stomach. These are known as duodenal ulcers.
Both stomach and duodenal ulcers are sometimes referred to as peptic ulcers. Here the term stomach ulcer will be used, although the information applies equally to duodenal ulcers.
The most common symptom of a stomach ulcer is a burning or gnawing pain in the centre of the tummy (abdomen).
But stomach ulcers aren't always painful and some people may experience other symptoms, such as indigestion, heartburn and feeling sick.
Read more about the symptoms of a stomach ulcer and diagnosing a stomach ulcer.
You should visit your GP if you think you may have a stomach ulcer.
Seek urgent medical advice if you experience any of the following symptoms:
- vomiting blood – the blood can appear bright red or have a dark brown, grainy appearance, similar to coffee grounds
- passing dark, sticky, tar- stools
- a sudden, sharp pain in your tummy that gets steadily worse
These could be a sign of a serious complication, such as internal bleeding.
Stomach ulcers occur when the layer that protects the stomach lining from stomach acid breaks down, which allows the stomach lining to become damaged.
This is usually a result of:
It used to be thought that stress or certain foods might cause stomach ulcers, but there's little evidence to suggest this is the case.
Read more about the causes of stomach ulcers.
It's not known how many people have stomach ulcers, although they're thought to be quite common.
Stomach ulcers can affect people of any age, including children, but mostly occur in people aged 60 or over. Men are more commonly affected than women.
With treatment, most stomach ulcers will heal within a month or two. The treatment recommended for you will depend on what caused the ulcer.
Most people will be prescribed a medication called a proton pump inhibitor (PPI) to reduce the amount of acid their stomach produces and allow the ulcer to heal naturally.
If an H. pylori infection is responsible for the ulcers, antibiotics will also be used to kill the bacteria, which should prevent the ulcer coming back.
If the ulcers are caused by the use of NSAIDs, PPIs are usually prescribed and your doctor will discuss whether you should keep using NSAIDs.
Alternative medication to NSAIDs, such as paracetamol, may be recommended.
Stomach ulcers can come back after treatment, although this is less ly to happen if the underlying cause is addressed.
Read more about treating stomach ulcers.
Complications of stomach ulcers are relatively uncommon, but they can be very serious and potentially life threatening.
The main complications include:
- bleeding at the site of the ulcer
- the stomach lining at the site of the ulcer splitting open (perforation)
- the ulcer blocking the movement of food through the digestive system (gastric obstruction)
Read more about the complications of stomach ulcers.
Symptoms & Causes of Peptic Ulcers (Stomach Ulcers) | NIDDK
A dull or burning pain in your stomach is the most common symptom of a peptic ulcer. You may feel the pain anywhere between your belly button and breastbone. The pain most often
- happens when your stomach is empty—such as between meals or during the night
- stops briefly if you eat or if you take antacids
- lasts for minutes to hours
- comes and goes for several days, weeks, or months
Less common symptoms may include
- feeling sick to your stomach
- poor appetite
- weight loss
Even if your symptoms are mild, you may have a peptic ulcer. You should see your doctor to talk about your symptoms. Without treatment, your peptic ulcer can get worse.
A dull or burning pain in your stomach is the most common symptom of peptic ulcers.
What causes a peptic ulcer?
Causes of peptic ulcers include
Sometimes peptic ulcers are caused by both NSAIDs and H. pylori.
How do NSAIDs cause a peptic ulcer?
To understand how NSAIDs cause peptic ulcer disease, it is important to understand how NSAIDs work. Nonsteroidal anti-inflammatory drugs reduce pain, fever, and inflammation, or swelling.
Everyone has two enzymes that produce chemicals in your body’s cells that promote pain, inflammation, and fever. NSAIDs work by blocking or reducing the amount of these enzymes that your body makes.
However, one of the enzymes also produces another type of chemical that protects the stomach lining from stomach acid and helps control bleeding.
When NSAIDs block or reduce the amount of this enzyme in your body, they also increase your chance of developing a peptic ulcer.
How do H. pylori cause a peptic ulcer and peptic ulcer disease?
H. pylori are spiral-shaped bacteria that can cause peptic ulcer disease by damaging the mucous coating that protects the lining of the stomach and duodenum. Once H. pylori have damaged the mucous coating, powerful stomach acid can get through to the sensitive lining. Together, the stomach acid and H. pylori irritate the lining of the stomach or duodenum and cause a peptic ulcer.
How do tumors from ZES cause peptic ulcers?
Zollinger-Ellison syndrome is a rare disorder that happens when one or more tumors form in your pancreas and duodenum. The tumors release large amounts of gastrin, a hormone that causes your stomach to produce large amounts of acid. The extra acid causes peptic ulcers to form in your duodenum and in the upper intestine.
When should you call or see a doctor?
You should call or see your doctor right away if you
- feel weak or faint
- have difficulty breathing
- have red blood in your vomit or vomit that looks coffee grounds
- have red blood in your stool or black stools
- have sudden, sharp stomach pain that doesn’t go away
These symptoms could be signs that a peptic ulcer has caused a more serious problem.
Call your doctor if the pain gets worse.
Peptic Ulcers (Stomach Ulcers)
You have a peptic ulcer if you get open sores in the lining of your stomach or the upper part of the small intestine.
That happens when your stomach acids etch away your digestive tract’s protective layer of mucus. You may have no symptoms, or you may feel discomfort or burning pain.
Peptic ulcers can lead to internal bleeding, which sometimes can mean you’ll need blood transfusions in the hospital.
You can have two types of peptic ulcer disease:
Gastric ulcer. You get this on your stomach lining.
Duodenal ulcer. This appears at the top end of the small intestine, an organ that digests and absorbs much of the food you eat.
You can have ulcers at any age, but your chances go up as you get older.
Ulcers form when digestive juices damage the walls of the stomach or small intestine. If the mucus layer gets too thin or your stomach makes too much acid, your gut will feel it. The two major causes are:
Bacteria. It’s called Helicobacter pylori (H. pylori), and as many as half of us carry it. Most people infected with H. pylori do not get ulcers.
But in others, it can raise the amount of acid, break down the protective mucus layer, and irritate the digestive tract. Experts aren’t sure how H. pylori infection spreads.
They think it may pass from person to person through close contact, kissing. You may also get it from unclean food and water.
Certain pain relievers. If you’ve been taking aspirin often and for a long time, you’re more ly to get a peptic ulcer. The same is true for other nonsteroidal anti-inflammatory drugs (NSAIDs).
They include ibuprofen and naproxen. NSAIDs block your body from making a chemical that helps protect the inner walls of your stomach and small intestine from stomach acid.
Other types of pain meds, such as acetaminophen, won’t lead to peptic ulcers.
Smoking cigarettes and drinking alcohol also can make you more ly to get ulcers. Stress and eating a lot of spicy food don’t cause ulcers, as experts once thought. But they can make ulcers worse and harder to treat.
You’ll most ly feel a burning pain or discomfort between your belly button and breastbone. You might especially notice it on an empty stomach — such as between meals or at night. The pain may stop for a little while if you eat or take an antacid, but then return. The pain can last for a few minutes or a few hours, and may come and go for many days or weeks.
Other symptoms may include:
- Bloated feeling
- Lack of appetite or weight loss
- Bloody or dark poop
Small ulcers may not cause any symptoms. But if you notice any of these signs, talk to your doctor.
Your doctor will ask about your symptoms, whether you take NSAIDs and other drugs, and medical history. She’ll also check you for bloating in the belly and pain. That may be enough to make a diagnosis.
The only way your doctor can tell for sure if you have an ulcer is to look. She may use a series of X-rays or a test called an endoscopy.
This test allows her to pass a thin, bendy tube down your throat and into your stomach and small intestine. The tube has a camera at the end so she can check the lining for ulcers.
She may also take a small piece of the lining to test for H. pylori. Blood, breath, and stool sample tests also can screen for the bacteria.
Some peptic ulcers heal on their own. But if you don’t treat them, the ulcers tend to come back.
They can erode the blood vessel wall in your stomach or small intestine. The ulcers also can eat a hole through the lining and get infected. Or they can cause swelling, which may block food from moving from your stomach into your small intestine.
If H. pylori is the culprit, your doctor may prescribe a mix of antibiotics to kill it. If aspirin and other NSAIDs are behind the ulcer, you may need to cut down on them, stop taking them altogether, or switch to another pain reliever.
Your doctor may also give you antacids to fight stomach acid, or prescribe medicine to lessen the acid your body makes. Prescription drugs called cytoprotective agents can help protect the lining of the stomach or small intestine so the ulcer can heal.
UpToDate: “Patient education: Peptic ulcer disease (Beyond the Basics).”
American College of Gastroenterology: “Peptic Ulcer Disease.”
Medical University of South Carolina Digestive Disease Center: “Peptic Ulcers.”
Mayo Clinic: “Peptic Ulcer.”
CDC: “Helicobacter pylori.”
National Institute of Diabetes and Digestive and Kidney Diseases: “Peptic Ulcers.”
American Academy of Family Physicians: “Peptic Ulcer Disease.”
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Peptic ulcers: Symptoms, causes, and treatments
A peptic ulcer is a sore that forms when digestive juices wear away the lining of the digestive system. A peptic ulcer can occur in the lining of the stomach, duodenum, or lower part of the esophagus. Symptoms can include indigestion- pain, nausea, and weight loss.
Globally, it is estimated that up to 10 percent of adults are affected by peptic ulcers at least once in their lifetime. In the United States, around 500,000 people develop a peptic ulcer each year.
When a peptic ulcer affects the stomach, it is called a gastric ulcer, one in the duodenum is called a duodenal ulcer, and an esophageal ulcer is an ulcer in the esophagus.
The most common causes are Helicobacter pylori (H. pylori) bacteria and the use of non-steroidal anti-inflammatory drugs.
- Peptic ulcers can affect anywhere in the digestive system.
- Symptoms include stomach pain, sometimes feeling indigestion, and nausea.
- Causes include bacteria and certain types of medication.
- Treatments include proton pump inhibitors (PPIs) and antibiotics.
Share on PinterestPeptic ulcers affect the digestive system.
It is not uncommon for people to have a peptic ulcer and no symptoms at all. However, one of the most common symptoms of peptic ulcers is indigestion- pain.
The pain may occur anywhere from the belly button to the breastbone. It can be brief or may last for hours. It is more severe when the stomach is empty or right after eating (depending on where it is located); sometimes it is worse during sleep. Eating certain foods may relieve it, and some foods may make it worse.
Other symptoms include:
- difficulty swallowing food
- food that is eaten comes back up
- feeling unwell after eating
- weight loss
- loss of appetite
Over-the-counter medications can often provide relief for these symptoms. Rarely, ulcers can cause severe signs and symptoms, such as:
- vomiting blood
- black and tarry stools, or stools with dark red blood
- nausea and vomiting that is especially persistent and severe
These symptoms indicate a medical emergency. The patient should see a doctor immediately.
The risk of complications increases if the ulcer is left untreated, or if treatment is not completed. Complications can include:
- internal bleeding
- hemodynamic instability, a result of internal bleeding which can affect multiple organs and be a serious complication
- peritonitis, in which the ulcer bores a hole through the wall of the stomach or small intestine
- scar tissue
- pyloric stenosis, a chronic inflammation in the lining of the stomach or duodenum
Peptic ulcers can recur. Having a first ulcer increases the risk of developing another one later.
The type of treatment usually depends on what caused the peptic ulcer. Treatment will focus on either lowering stomach acid levels so that the ulcer can heal, or eradicating the H. pylori infection.
Proton pump inhibitors (PPIs)
PPIs reduce the amount of acid the stomach produces. They are prescribed for patients who test negative for H. pylori infection. Treatment usually lasts 1-2 months, but if the ulcer is severe, treatment may last longer.
H. pylori infection treatment
Patients infected with H. pylori will usually need PPIs and antibiotics. This treatment is effective in most patients, and the ulcer will start to disappear within days. When treatment is over, the individual will have to be tested again to make sure the H. pylori have gone. If necessary, they will undergo another course of different antibiotics.
Non-steroidal anti-inflammatory drugs
If the ulcer comes from NSAIDs, the patient will have to stop taking them. Alternatives include acetaminophen. If the person cannot stop taking NSAIDs, the doctor may minimize the dosage and review the patient’s need for them later. Another medication may be prescribed long term, alongside the NSAID.
Even after the ulcer has healed and treatment has been completed, the patient may still have indigestion. In such cases, the doctor might advise some diet and lifestyle changes. If symptoms persist, low-dose PPI or H2-receptor antagonists might be prescribed. In severe cases with bleeding, an endoscopy may be needed to stop the bleeding at the ulcer site.
Dietary changes can be important for treating and preventing peptic ulcers.
It is important to avoid foods and flavorings that induce the stomach to produce acids, such as chili powder, garlic, black pepper, and caffeine. Alcohol has the same effect on the stomach and should also be avoided.
The diet should contain plenty of foods that provide plenty of vitamin A and fiber that dissolves easily. These can include:
Sources of soluble fiber
- psyllium husk
- flax seeds
Sources of vitamin A
- sweet potatoes
- collard greens
Foods that are high in antioxidants, such as a range of berries and snap peas, are recommended. Green tea has also demonstrated a restrictive effect on the growth of H. pyloriunder laboratory conditions. However, it is unclear whether it would have the same impact inside the human body.
A balanced diet filled with fruits and vegetables and lacking in intense spices and flavors should assist with a peptic ulcer.
Peptic ulcers normally occur because of:
- H. pylori bacteria
- non-steroidal anti-inflammatory drugs (NSAIDs)
H. pylori bacteria are responsible for the majority of gastric and duodenal ulcers. NSAIDs are a less ly cause.
How does H. pylori cause ulcers?
Although many people naturally carry H. pylori, it is not clear why the bacteria only cause ulcers in some people. H. pylori spread through food and water. They live in the mucus that coats the lining of the stomach and duodenum, and they produce urease, an enzyme that neutralizes stomach acid by making it less acidic.
To compensate for this, the stomach produces more acid, and this irritates the stomach lining. The bacteria also weaken the defense system of the stomach and causes inflammation. Patients with peptic ulcers caused by H. pylori need treatment to get rid of the bacterium from the stomach, and to prevent them coming back.
How do non-steroidal anti-inflammatory drugs cause ulcers?
Non-steroidal anti-inflammatory drugs (NSAIDS) are medications for headaches, period pains, and other pains. Examples include aspirin and ibuprofen. Many NSAIDs are available without a prescription.
They lower the stomach’s ability to make a protective layer of mucus. This makes it more susceptible to damage by stomach acid. NSAIDs can also affect the flow of blood to the stomach, reducing the body’s ability to repair cells.
Other causes of peptic ulcers
- Genetics: A significant number of individuals with peptic ulcers have close relatives with the same problem, suggesting that genetic factors may be involved.
- Smoking: People who regularly smoke tobacco are more ly to develop peptic ulcers when compared with non-smokers.
- Alcohol consumption: Regular heavy drinkers of alcohol have a higher risk of developing peptic ulcers.
- Corticosteroid use: People on large or chronic doses of corticosteroids are also at greater risk.
- Mental stress: This stress has not been linked to the development of new peptic ulcers, but symptoms appear to be more severe in people with ulcers who are experiencing ongoing mental stress.
Share on PinterestBlood tests are a method of diagnosis for peptic ulcers.
A patient’s description of symptoms will normally cause a doctor to suspect a peptic ulcer.
Tests that can confirm a diagnosis include:
- a blood test to check for H. pylori, though a positive test does not always mean there is an active infection
- a breath test, using a radioactive carbon atom to detect H. pylori
- a stool antigen test to detect H. pylori in the feces
- an upper gastrointestinal (GI) X-ray to identify ulcers
An endoscopy may also be used. This involves a long, narrow tube with a camera attached to the end is threaded down the patient’s throat and into the stomach and duodenum. This is the best diagnostic test.
If an ulcer is detected, the doctor may take a biopsy (a small sample of tissue) for examination under a microscope. A biopsy can test for H. pylori and look for evidence of cancer. The endoscopy may be repeated a few months later to determine whether the ulcer is healing.
The outlook for a person with a peptic ulcer is generally excellent.
They can be painful and debilitating, but a peptic ulcer can be successfully treated and prevented from returning in almost all cases.
Treating H. pylori infection and avoiding NSAIDs can ensure that the problem does not recur.
Stomach ulcer (Gastric ulcer)
If you have a stomach ulcer, your treatment will depend on what caused it.
With treatment, most ulcers heal in a month or two.
Treating Helicobacter pylori (H. pylori) infection
If your stomach ulcer's caused by a Helicobacter pylori (H. pylori) bacterial infection, you'll be given:
- a course of antibiotics
- a medication called a proton pump inhibitor (PPI)
This is also recommended if it's thought your stomach ulcer's caused by a combination of an H. pylori infection and non-steroidal anti-inflammatory drugs (NSAIDs).
If you have an H. pylori infection, you'll usually be prescribed a course of 2 or 3 antibiotics.
The most commonly used antibiotics are:
You should take these twice a day for a week.
The side effects of these are usually mild, but can include:
- feeling and being sick
- a metallic taste in your mouth
You'll be re-tested at least 4 weeks after finishing your antibiotic course to see if there are any H. pylori bacteria left in your stomach. If there are, a further course of eradication therapy using different antibiotics may be given.
Ulcers caused by NSAIDs
If your stomach ulcer's caused by taking NSAIDs:
- you'll be given a course of PPI medication
- your use of NSAIDs will be reviewed, and you may be advised to use an alternative painkiller
You may be advised to use an alternative painkiller not associated with stomach ulcers, such as paracetamol.
COX-2 inhibitors are sometimes recommended. These are an alternative type of NSAID that's less ly to cause stomach ulcers.
If you're taking low-dose aspirin to reduce your risk of blood clots, your GP will tell you whether you need to keep taking it.
If you do, you may also be prescribed long-term treatment with a PPI or H2-receptor antagonist to prevent further ulcers.
Sometimes a type of medication called H2-receptor antagonists are used instead of PPIs.
These also reduce the amount of acid your stomach produces.
Ranitidine is the most widely used H2-receptor antagonist for treating stomach ulcers.
Antacids and alginates
As these treatments can take several hours before they start to work, your GP may recommend taking additional antacid medication.
- neutralise your stomach acid
- provide immediate, but short-term, symptom relief
- should be taken when you experience symptoms or when you expect them, such as after meals or at bedtime
Some antacids also contain a medicine called an alginate, which produces a protective coating on the lining of your stomach. Antacids containing alginates are best taken after meals.
You can buy these medications at pharmacies. Your pharmacist can tell you which is most suitable for you.
There aren't any special lifestyle measures you need to take during treatment.
However, avoiding stress, alcohol, spicy foods and smoking may reduce your symptoms while your ulcer heals.
Stomach ulcers: Causes, symptoms, and treatment
- When to see a doctor
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Stomach ulcers are sores in the lining of the stomach or small intestine. They occur when the protective mucus that lines the stomach becomes ineffective.
The stomach produces a strong acid to help digest food and protect against microbes. To protect the tissues of the body from this acid, it also secretes a thick layer of mucus.
If the mucus layer is worn away and stops functioning effectively, the acid can damage the stomach tissue, causing an ulcer.
An estimated one in every ten people in Western countries will have an ulcer in the stomach or small intestine at some point in their lives.
Stomach ulcers are relatively easy to cure, but they can cause significant problems if left untreated.
Having a support system that’s been there and understands is important. IBD Healthline is a free app for people that have faced conditions that can cause stomach ulcers. The app is available on the AppStore and Google Play. Download here: https://go.onelink.me/LOC7/ebe34bcc.
Here are some key points about stomach ulcers. More detail and supporting information is in the main article.
- Stomach ulcers are common in the West and easy to treat but can become serious.
- The most common causes are bacteria and use of nonsteroidal anti-inflammatory drugs (NSAIDs).
- The classic symptom of a stomach ulcer is indigestion.
- Treatment for stomach ulcers normally focuses on removing the cause.
Share on PinterestPain is the main symptom of a stomach ulcer, either around the stomach or slightly higher up.
The classic symptom of a stomach ulcer is indigestion, also called dyspepsia.
Indigestion causes pain or discomfort in the stomach area. This symptom can be mistaken for heartburn, which can occur at the same time.
Heartburn can be caused by acid reflux or gastroesophageal reflux disease (GERD). It occurs slightly higher up from the stomach and is felt in the lower part of the chest.
It is worth noting that not all stomach ulcers cause indigestion.
Stomach ulcer symptoms tend to be more distinct than heartburn, but symptoms can still be vague.
An ulcer tends to produce a burning or dull pain in the stomach area. This pain is sometimes described as a “biting” or “gnawing” pain. Some people may describe a hungry sensation.
Other symptoms include:
- weight loss
- nausea and vomiting
- not eating because of pain
- pain may be relieved by eating, drinking, or taking antacids
Some stomach ulcers go unnoticed and show no typical indigestion-type pains. These ulcers are less common and tend to be diagnosed after the ulcer has started bleeding. Some ulcers can cause a hole in the stomach wall. This is known as perforation and is a serious condition.
Stomach ulcer symptoms often change over time and can be difficult to spot.
Dietary changes can help prevent stomach ulcers from developing.
People at risk of stomach ulcers should include more of the following nutrients in their diet:
- Fruits and vegetables: Eating a variety of fruits and vegetables is key to a healthy digestive tract lining. These foods are rich in antioxidants, inhibit acid secretion, and contain cytoprotective and anti-inflammatory properties. A 2017 study advises that these are all important factors for preventing and treating ulcers.
- Fiber: Diets high in soluble dietary fiber reduce the risk of developing stomach ulcers.
- Probiotics: Food that contains active bacterial content, such as probiotic yogurt, can help to reduce a Helicobacter pylori (H. pylori)infection. Probiotics have been shown to slightly improve symptoms of indigestion and the side effects of antibiotics.
- Vitamin C: This powerful antioxidant may be effective in helping to eradicate H. pylori, especially when taken in small doses over an extended period. Fruits, legumes, and vegetables, such as oranges and tomatoes, contain high levels of vitamin C.
- Zinc: This micronutrient is important for maintaining a healthy immune system and healing wounds. Oysters, spinach, and beef contain high levels of zinc.
- Selenium: This may reduce the risk of infection complications and may also promote healing. Brazil nuts, yellowfin tuna, and halibut are recommended for their high selenium content.
Avoiding alcohol and caffeine can also help reduce the risk, as they both cause the body to produce more gastric acid. This can lead to stomach ulcers.
It is important to use dietary options to support a treatment plan for the most effective outcome, as opposed to relying only on diet.
Share on PinterestA class of painkillers known as NSAIDs can increase the risk of stomach ulcers.
The two main causes of ulcers of the stomach and small intestine are:
- H. pylori bacteria
- a class of painkillers called nonsteroidal anti-inflammatory drugs (NSAIDs)
Less common causes of stomach ulcers include:
- Excess stomach acidity, or hyperacidity: This can occur for a range of reasons, including genetics, smoking, stress, and some foods.
- Zollinger-Ellison syndrome: This is a rare disease that causes an excess of stomach acid to be produced.
Certain behaviors and factors increase the chances of developing a stomach ulcer.
- frequent steroid usage
- overproducing calcium, or hypercalcemia
- consuming alcohol frequently
Stomach ulcers are more common in individuals over 50 years of age. People can develop a stomach ulcer at any age, but they are much less common in children. The risk in children is higher if their parents smoke.
NSAID drugs and stomach ulcers
A group of painkillers known as NSAIDs carries a risk of stomach ulcers. The two best-known NSAIDs are aspirin and ibuprofen.
The risk of ulcers increases if the drugs are taken in high doses, or regularly for a long time.
Stronger NSAIDs, such as those that need a prescription, are riskier for stomach ulcers than those that can be bought over-the-counter (OTC).
People should always check labels and talk to a pharmacist or a doctor about any concerns with using painkillers. They may recommend an alternative such as acetaminophen.
Stomach ulcers are one type of peptic ulcers.
There are two other types: Esophageal and duodenal ulcers. Esophageal ulcers form inside the esophagus, and duodenal ulcers occur in the uppermost part of the small intestine, known as the duodenum.
The ulcers share similar characteristics but are identified by their location in the body.
If the doctor thinks there is a stomach ulcer, they may try to remove the cause by:
- changing the type of painkiller if the cause is thought to be NSAIDs
- trying the “test-and-treat” approach if the cause is thought to be H. pylori bacteria
Once the cause has been removed, the symptoms of stomach ulcers can be treated by protecting the ulcer from acid while it heals. Drugs a doctor could prescribe include:
- proton pump inhibitors (PPI) that block acid-producing cells
- H2-receptor antagonists, which prevent the stomach from producing excess acid
- antacids or alginate. These are available to purchase over-the-counter or online.
- drugs that protect the stomach lining, such as Pepto-Bismol, available to purchase online.
Symptoms often subside quickly following treatment. However, the treatment should be continued, especially if the ulcer is due to an H. pylori infection. It is also important to avoid drinking alcohol, smoking tobacco, and any trigger foods during treatment.
In certain cases, surgery may be an option. For instance, if the ulcer continues to return, will not heal, bleeds, or prevents food from leaving the stomach.
Surgery can include:
- removing the ulcer
- tying off bleeding blood vessels
- sewing tissue from another site onto the ulcer
- cutting the nerve that controls stomach acid production
Complications from stomach ulcers such as bleeding or perforation are rare. Either of these complications requires urgent medical attention.
Doctors follow the symptoms of a stomach ulcer by asking questions about how the pain feels, where and when it happens, and how frequent and long-lasting it has been.
This process helps to narrow down whether there is a stomach ulcer or not. Your doctor may also ask for a stool test or a breath test to find out whether the stomach ulcer is from H. pylori bacteria.
If there are more serious symptoms such as bleeding the doctor may require further testing, which may include:
- Endoscopy: A camera is inserted at the end of a long, thin, flexible tube to look at the gut lining. A biopsy may also be taken.
- Barium enema: This is a thick liquid that allows X-rays to be taken of the gut.
Anyone who thinks they may have an ulcer in their stomach should consult their doctor. Any stomach symptoms that last for more than a few days or keep happening need evaluation and treatment.
A slow-bleeding ulcer can be signaled by symptoms of anemia, such as being tired and breathless. More serious bleeding is an urgent medical problem and can be signaled if blood is vomited up, or stools are black and sticky.
Perforation, or a hole in the stomach, is also an emergency. Without quick treatment, the wall of the stomach can become infected. Sudden stomach pain that gets worse can indicate perforation, and any signs of being very unwell with infection need treatment as soon as possible.
Peptic Ulcer: Causes, Treatment, and Prevention
Peptic ulcers are sores that develop in the lining of the stomach, lower esophagus, or small intestine. They’re usually formed as a result of inflammation caused by the bacteria H. pylori, as well as from erosion from stomach acids. Peptic ulcers are a fairly common health problem.
There are three types of peptic ulcers:
- gastric ulcers: ulcers that develop inside the stomach
- esophageal ulcers: ulcers that develop inside the esophagus
- duodenal ulcers: ulcers that develop in the upper section of the small intestines, called the duodenum
Different factors can cause the lining of the stomach, the esophagus, and the small intestine to break down. These include:
- Helicobacter pylori (H. pylori), a type of bacteria that can cause a stomach infection and inflammation
- frequent use of aspirin (Bayer), ibuprofen (Advil), and other anti-inflammatory drugs (risk associated with this behavior increases in women and people over the age of 60)
- drinking too much alcohol
- radiation therapy
- stomach cancer
The most common symptom of a peptic ulcer is burning abdominal pain that extends from the navel to the chest, which can range from mild to severe. In some cases, the pain may wake you up at night. Small peptic ulcers may not produce any symptoms in the early phases.
Other common signs of a peptic ulcer include:
Two types of tests are available to diagnose a peptic ulcer. They are called upper endoscopy and upper gastrointestinal (GI) series.
In this procedure, your doctor inserts a long tube with a camera down your throat and into your stomach and small intestine to examine the area for ulcers. This instrument also allows your doctor to remove tissue samples for examination.
Not all cases require an upper endoscopy. However, this procedure is recommended for people with a higher risk of stomach cancer. This includes people over the age of 45, as well as people who experience:
- weight loss
- gastrointestinal bleeding
- difficulty swallowing
If you don’t have difficulty swallowing and have a low risk of stomach cancer, your doctor may recommend an upper GI test instead. For this procedure, you’ll drink a thick liquid called barium (barium swallow). Then a technician will take an X-ray of your stomach, esophagus, and small intestine. The liquid will make it possible for your doctor to view and treat the ulcer.
Because H. pylori is a cause of peptic ulcers, your doctor will also run a test to check for this infection in your stomach.
Treatment will depend on the underlying cause of your ulcer. If tests show that you have an H. pylori infection, your doctor will prescribe a combination of medication. You’ll have to take the medications for up to two weeks. The medications include antibiotics to help kill infections and proton pump inhibitors(PPIs) to help reduce stomach acid.
You may experience minor side effects diarrhea or an upset stomach from antibiotic regimens. If these side effects cause significant discomfort or don’t get better over time, talk to your doctor.
If your doctor determines that you don’t have an H. pylori infection, they may recommend a prescription or over-the-counter PPI (such as Prilosec or Prevacid) for up to eight weeks to reduce stomach acid and help your ulcer heal.
Acid blockers ranitidine (Zantac) or famotidine (Pepcid) can also reduce stomach acid and ulcer pain. These medications are available as a prescription and also over the counter in lower doses.
Your doctor may also prescribe sucralfate (Carafate) which will coat your stomach and reduce symptoms of peptic ulcers.
Shop for acid blockers.
Untreated ulcers can become worse over time. They can lead to other more serious health complications such as:
- Perforation: A hole develops in the lining of the stomach or small intestine and causes an infection. A sign of a perforated ulcer is sudden, severe abdominal pain.
- Internal bleeding: Bleeding ulcers can result in significant blood loss and thus require hospitalization. Signs of a bleeding ulcer include lightheadedness, dizziness, and black stools.
- Scar tissue: This is thick tissue that develops after an injury. This tissue makes it difficult for food to pass through your digestive tract. Signs of scar tissue include vomiting and weight loss.
All three complications are serious and may require surgery. Seek urgent medical attention if you experience the following symptoms:
- sudden, sharp abdominal pain
- fainting, excessive sweating, or confusion, as these may be signs of shock
- blood in vomit or stool
- abdomen that’s hard to the touch
- abdominal pain that worsens with movement but improves with lying completely still
With proper treatment, most peptic ulcers heal. However, you may not heal if you stop taking your medication early or continue to use tobacco, alcohol, and nonsteroidal pain relievers during treatment. Your doctor will schedule a follow-up appointment after your initial treatment to evaluate your recovery.
Some ulcers, called refractory ulcers, don’t heal with treatment. If your ulcer doesn’t heal with the initial treatment, this can indicate:
- an excessive production of stomach acid
- presence of bacteria other than H. pylori in the stomach
- another disease, such as stomach cancer or Crohn’s disease
Your doctor may offer a different method of treatment or run additional tests to rule out stomach cancer and other gastrointestinal diseases.
Certain lifestyle choices and habits can reduce your risk of developing peptic ulcers. These include:
- not drinking more than two alcoholic beverages a day
- not mixing alcohol with medication
- washing your hands frequently to avoid infections
- limiting your use of ibuprofen, aspirin, and naproxen (Aleve)
Maintaining a healthy lifestyle by quitting smoking cigarettes and other tobacco use and eating a balanced diet rich in fruits, vegetables, and whole grains will help you prevent developing a peptic ulcer.