Peptic ulcers are open sores in your digestive tract. When they’re located inside your stomach, they’re also called gastric ulcers. When they are found in the upper part of your small intestine, they are called duodenal ulcers.

Some people aren’t even aware they have an ulcer. Others have symptoms like heartburn and abdominal pain. Ulcers can become very dangerous if they perforate the gut or bleed heavily (also known as a hemorrhage).

Keep reading to learn more about symptoms and treatment for ulcers, as well as to uncover a few ulcer myths.

Ulcers don’t always cause symptoms. In fact, only about one quarter of people with ulcers experience symptoms. Some of these symptoms include:

Symptoms may be a little different for each person. In some cases, eating a meal can ease the pain. In others, eating only makes things worse.

An ulcer can bleed so slowly that you don’t notice it. The first signs of a slow-bleeding ulcer are symptoms of anemia, which include:

An ulcer that is bleeding heavily may cause:

Rapid bleeding from an ulcer is a life-threatening event. If you have these symptoms, seek immediate medical attention.

There’s a layer of mucus in your digestive tract that helps protect the gut lining. When there’s too much acid or not enough mucus, the acid erodes the surface of your stomach or small intestine. The result is an open sore that can bleed.

Why this happens can’t always be determined. The two most common causes are Helicobacter pylori and nonsteroidal anti-inflammatory drugs.

Helicobacter pylori (H. pylori)

H. pylori is a bacterium that lives within the mucus in the digestive tract. It can sometimes cause inflammation in the stomach lining, which leads to an ulcer. The risk may be greater if you are infected with H. pylori and you also smoke.

Nonsteroidal anti-inflammatory drugs (NSAIDs)

These medications make it hard for your stomach and small intestine to protect themselves from stomach acids. NSAIDs also reduce the ability of your blood to clot, which can make a bleeding ulcer much more dangerous.

Drugs in this group include:

Acetaminophen (Tylenol) is not an NSAID.

NSAIDS are also included in some combination medications used to treat stomach upset or colds. If you’re using multiple medications, there’s a good chance you’re taking more NSAIDs than you realize.

The risk of developing an ulcer caused by NSAIDs is greater if you:

  • take a higher than normal dose
  • take them too frequently
  • drink alcohol
  • are elderly
  • use corticosteroids
  • have had ulcers in the past

Additional risk factors

Zollinger-Ellison syndrome is another condition that can lead to ulcers. It causes gastrinomas, or tumors of the acid-producing cells in your stomach, which causes more acid.

Another rare type of ulcer is called Cameron’s ulcer. These ulcers occur when a person has a large hiatal hernia and often cause GI bleeding.

If you have ulcer symptoms, see your doctor. Prompt treatment can prevent excessive bleeding and other complications.

Ulcers are usually diagnosed after an upper GI endoscopy (EGD or esophagogastroduodenoscopy). An endoscope is a long flexible tube with a light and camera on the end. The tube is inserted into your throat, then to the esophagus, stomach, and upper part of the small intestine. Learn how to prepare for an endoscopy here.

Generally performed as an outpatient procedure, it allows the doctor to locate and identify problems in the stomach and upper intestine.

Bleeding ulcers must be addressed quickly, and treatment can start during the initial endoscopy. If bleeding from ulcers is found during the endoscopy, the doctor can:

  • inject medication directly
  • cauterize the ulcer to stop the bleeding
  • clamp off the bleeding vessel

If you have an ulcer, you’ll be tested for H. pylori. This can be done using a tissue sample taken during the endoscopy. It can also be accomplished with noninvasive tests such as a stool sample or breath test.

If you have the infection, antibiotics and other drugs can help fight the bacteria and ease symptoms. To be certain you get rid of it, you must finish taking the medication as directed, even if your symptoms stop.

Ulcers are treated with acid-blocking drugs called proton pump inhibitors (PPIs) or H2 blockers. They can be taken orally, but if you have a bleeding ulcer, they can also be taken intravenously. Cameron ulcers are usually treated with PPIs, but sometimes surgery is needed to repair the hiatal hernia.

If your ulcers are the result of taking too many NSAIDs, work with your doctor to find another medication to treat pain.

Over-the-counter antacids sometimes relieve symptoms. Ask your doctor if it’s okay to take antacids.

You’ll have to take medication for at least a few weeks. You should also avoid taking NSAIDs going forward.

If you have severely bleeding ulcers, your doctor may want to perform another endoscopy at a later date to be certain that you’re fully healed and that you don’t have more ulcers.

An untreated ulcer that swells or scars can block your digestive tract. It can also perforate your stomach or small intestine, infecting your abdominal cavity. That causes a condition known as peritonitis.

A bleeding ulcer can lead to anemia, bloody vomit, or bloody stools. A bleeding ulcer usually results in a hospital stay. Severe internal bleeding is life-threatening. Perforation or serious bleeding may require surgical intervention.

Ulcers can be successfully treated, and most people heal well. When treated with antibiotics and other medications, the success rate is 80 to 90 percent.

Treatment will only be effective if you take all your medication as prescribed. Smoking and continued use of NSAIDs will impede healing. Also, some strains of H. pylori are antibiotic resistant, complicating your long-term outlook.

If you’re hospitalized due to a bleeding ulcer, the 30-day mortality rate is about 11 percent. Age, recurrent bleeding, and comorbidity are factors in this outcome. The main predictors for long-term mortality include:

  • old age
  • comorbidity
  • severe anemia
  • tobacco use
  • being male

There’s a lot of misinformation about ulcers, including what causes them. For a long time, it was thought that ulcers were due to:

  • stress
  • worry
  • anxiety
  • a rich diet
  • spicy or acidic foods

People with ulcers were advised to make lifestyle changes such as reducing stress and adopting a bland diet.

That changed when H. Pylori was discovered in 1982. Doctors now understand that while diet and lifestyle can irritate existing ulcers in some people, generally they do not cause ulcers. While stress can increase stomach acid that in turn irritates the gastric mucosa, stress is rarely the main cause of an ulcer. An exception is in individuals who are very ill, such as those in a critical care hospital unit.

Another longstanding myth is that drinking milk is good for ulcers. That may be because milk coats your stomach lining and relieves ulcer pain, at least for a short time. Unfortunately, milk encourages production of acid and digestive juices, which actually makes ulcers worse.