Peptic ulcers are sores that develop in the lining of the stomach, lower esophagus, or small intestine (the duodenum), usually 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 bacteria that can cause a stomach infection and inflammation
- frequent use of aspirin, ibuprofen, 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:
- changes in appetite
- bloody or dark stools (melena)
- unexplained weight loss
- chest pain
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 those who experience:
- anemia (a low number of red blood cells)
- 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, and 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, which you will have to take 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 like diarrhea or 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 (like Zantac or Pepcid) can also reduce stomach acid and ulcer pain. These medications are available as a prescription and also over the counter in lower doses.
Untreated ulcers can become worse over time and 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 medical emergencies that require surgery. Call your doctor if you feel dizzy or if symptoms return. 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
With proper treatment, most peptic ulcers heal. However, you may not heal if you stop taking your medication early or continue to use tobacco and 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 sodium
Maintaining a healthy lifestyle through a balanced diet rich in fruits, vegetables, and whole grains, and quitting smoking and other tobacco use will also help you prevent developing a peptic ulcer.