Peptic ulcer disease causes open and often painful sores in the lining of your stomach or the top of your small intestine, the area known as the duodenum.
Your stomach produces "pepsin," a major digestive enzyme that works with your stomach acid to break down food for digestion. Your gastrointestinal tract is naturally equipped with a protective mucus lining, but when that protective lining weakens, the powerful digestive acids damage the vulnerable tissues below, and ulcers can form.
There are two different types of peptic ulcers: stomach ulcers and duodenal ulcers. Stomach ulcers occur in the stomach, and duodenal ulcers are located in the duodenum, the first part of your small intestine. Peptic ulcers are common, affecting nearly six million people each year in the United States, according to the CDC. If left untreated, they can cause pain, bleeding, and other serious complications in your digestive tract.
Typically, a protective lining protects your gastrointestinal tract, but peptic ulcer disease can result in stomach acid bypassing that protective lining and painful ulcers forming.
But what can cause this mucous lining to wear down and cause sores to develop?
Common Causes of Peptic Ulcers:
H. pylori Infection (Helicobacter pylori)
A type of bacteria that lives in the mucous lining of your stomach and small intestine. Most people don’t experience any symptoms, but in others, it can lead to inflammation of the stomach lining, which can cause an ulcer.
H. pylori may be passed through close contact (like kissing) or through food and water, but it’s not always clear how it spreads.
Long-Term Use of Certain Pain Relievers
Frequent, long-term use of medications, nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil®, Motrin®), naproxen (Aleve®), or ketoprofen, or aspirin can irritate the stomach lining and increase the risk of ulcers.
These medications are commonly used for pain, inflammation, or arthritis.
Acetaminophen (Tylenol®) is typically gentler on the stomach and is not linked to ulcers in the same way.
If you have a history of frequent pain reliever use or believe you may have an H. pylori infection, schedule an appointment with Charleston GI today – no referral needed. Identifying the cause of your peptic ulcers is the first step toward treatment, relief, and healing.
RISK FACTORS
You may have a greater risk of developing a peptic ulcer if:
You have an H. pylori infection
You regularly take NSAID pain relievers like ibuprofen, naproxen, or aspirin
You have both an H. pylori infection and use NSAIDs (this combination can significantly increase your risk)
Additional Risk Factors
While these factors don’t generally cause ulcers on their own, they can increase the risk or worsen ulcers, especially if you already have H. pylori or take NSAIDs:
Stomach ulcer pain often feels worse within 30 minutes after eating, while duodenal ulcer pain may improve briefly after eating but return 2 to 3 hours later or at nighttime. If the ulcer is located in the esophagus, you may experience heartburn-like symptoms, especially at night.
COMPLICATIONS
Symptoms of Serious Complications
Many people do not experience symptoms until the ulcer causes a serious issue. Signs to be on the lookout for include:
Bleeding Ulcer (Upper GI Bleed):
Dark or black, tar-like stool
Blood in vomit (can look like coffee grounds)
Dizziness or fainting
Pale skin
Fast heart rate
Perforation (Hole in the Stomach or Intestine):
Sudden, sharp, severe stomach pain
Swollen, tender abdomen
Fever and chills
Blockage (Obstruction in the Digestive Tract):
Bloating and swelling
Frequent vomiting
Loss of appetite
Weight loss
Constipation or lack of bowel movements
Possible Complications of Untreated Peptic Ulcers
If not properly treated, peptic ulcers can lead to:
Bleeding: Can result in anemia or a medical emergency due to severe blood loss
Perforation: A hole in the stomach or small intestine, increasing the risk of serious infection
Digestive blockage: Caused by swelling or scar tissue, slowing or blocking food from passing through
Increased cancer risk: Long-term H. pylori infection raises the risk of stomach cancer
WHEN TO SEE A DOCTOR
If you suspect you have a peptic ulcer, visit your primary care provider or a gastroenterologist, like Charleston GI, as soon as you can.
While you may be able to manage or ease your symptoms with over-the-counter medications, they won’t fix the underlying issue. It’s time to identify and address the cause of your peptic ulcer. Leaving an ulcer untreated can lead to more serious complications, like cancer, even if your symptoms are mild.
Seek emergency care if you experience serious symptoms, like:
Persistent, severe pain
Signs of blood in your poop or vomit
Paleness and/or faintness (signs of severe blood loss)
DIAGNOSTIC TEST
If your symptoms suggest a peptic ulcer or an increased risk of developing one, your gastroenterologist may use several diagnostic tools to confirm its presence and check for H. pylori infection, a common cause of ulcers.
Standard Medical Exam
Assessment of medical history
Physical exams
Common Diagnostic Tests
Tests for H. pylori infection include:
Urea Breath Test:
You drink a liquid containing a harmless radioactive substance
If H. pylori is present, it breaks down the substance and releases carbon dioxide into your breath
Your breath is analyzed by blowing into a special bag
Stool Test:
Detects the presence of H. pylori in a stool sample
Blood Test:
Can detect past or current H. pylori infection
Not as commonly used now
It's essential to note that you may need to discontinue using antacids or antibiotics before testing, as they can affect the results.
Endoscopy (Upper Endoscopy or EGD)
An upper endoscopy is performed with a thin, flexible tube containing a camera is passed down your throat to view your esophagus, stomach, and small intestine.
Helps locate ulcers directly and assess your condition.
A biopsy (a small tissue sample) may be taken to:
Test for H. pylori infection
Rule out other conditions, like cancer
If bleeding is detected, your doctor may treat some ulcers during the procedure.
Often recommended for:
Older adults
People with bleeding, weight loss, or trouble swallowing
Used to confirm ulcer is healing after treatment
Upper GI Series (Barium Swallow)
A type of X-ray imaging that looks at your upper digestive tract.
Involves drinking a white liquid containing barium that coats the lining of your digestive system.
This coating allows your doctor to detect ulcers on X-ray images.
CT Scan (Computed Tomography)
CT scan may be recommended to detect larger ulcers or other complications.
Often ordered if symptoms are severe or unclear.
TREATMENT
Medications
Most peptic ulcers can be treated with medications, and your gastroenterologist may recommend a combination of the following:
Antibiotics for H. pylori or other bacterial infections
Cytoprotective Agents to protect the stomach lining
H2 Blockers, which block histamine receptors
Proton Pump Inhibitors (PPIs)
NSAID Alternative:
If NSAIDs contributed to your ulcer, your doctor may recommend that you stop using them
Acetaminophen is often recommended as a safer pain reliever option that doesn’t irritate the stomach lining
Medical Procedures
If complications arise, such as bleeding, a perforation, or a blockage, you may need additional treatment for your peptic ulcer:
Endoscopic Treatment
Performed during an upper endoscopy
Helps to stop bleeding ulcers through cauterization or medication injections
Can also take biopsies or assess healing during an endoscopy
Perforation Repair
Surgical repair may be required to fix a perforated ulcer
Treatment for Obstruction
If an ulcer causes a blockage in the digestive tract:
Suction may be used to decompress the stomach
In rare cases, surgery may be needed to reopen the blocked passage
PROGNOSIS: FOLLOW UP AFTER TREATMENT
Follow-Up After Peptic Ulcer Treatment
Most peptic ulcers can heal with medication and lifestyle changes. However, some ulcers may not heal as expected and are referred to as refractory ulcers.
What is a Refractory Ulcer?
An ulcer that doesn’t heal after eight to 12 weeks of treatment
Reasons the ulcer didn’t heal may include:
Not taking medications as prescribed
Antibiotic-resistant H. pylori infection
Continued use of NSAIDs (nonsteroidal anti-inflammatory drugs)
Less Common Causes of Non-Healing Ulcers
Some ulcers may not heal due to underlying health conditions, such as:
Overproduction of stomach acid
Other infections besides H. pylori
Stomach cancer
Other diseases that cause ulcer-like sores, such as Crohn’s disease
Next Steps If the Ulcer Doesn’t Heal
If your ulcer is not healing, your gastroenterologist may:
Reevaluate your medications and/or change the treatment plan
Recommend a different combination of antibiotics
Look into other possible causes through more testing
Advise you to quit smoking, as it can slow healing
Discuss stopping NSAID usage or switching to safer alternatives
When Additional Treatment Is Needed
In rare cases, more serious interventions may be required:
Endoscopy to treat bleeding or assess healing
Surgery if further complications occur, such as:
Severe bleeding
A perforation in the stomach or intestine
A blockage caused by swelling or scar tissue
PREVENTION
Common Prevention
Test for H. pylori and treat infection
A simple urea breath test can detect H. pylori
Treating it early can prevent ulcers
If you've been treated before, retesting is critical to see if the infection has returned
Use NSAIDs carefully
Only take NSAIDs as directed by your doctor
Avoid taking more than the recommended dose
If you have a history of ulcers, avoid NSAIDs if possible
If NSAIDs are necessary, your doctor may prescribe medication to protect your stomach lining
Lifestyle and Home Tips
Switch pain reliever medication if needed
Ask if acetaminophen (Tylenol) might be a safer option.
Manage stress
Stress can worsen ulcer symptoms.
Engage in stress-reducing activities such as exercise, meditation, deep breathing, journaling, or socializing with friends.
Quit smoking
Smoking negatively impacts the health of your stomach lining and increases acid production, raising ulcer risk and slowing healing.
Limit or avoid alcohol
Excessive alcohol can irritate and damage your stomach and intestinal lining, increasing the risk of ulcers.
Not all ulcers are painful, but ulcers can often cause a dull, burning, or gnawing pain in the upper abdominal area between the belly button and the breastbone. Ulcer pain can come and go, with the pain worsening when the stomach is empty or at night and being relieved by eating. It can sometimes radiate to the back or chest.
Do peptic ulcers go away on their own?
Peptic ulcers can heal if the conditions that caused them change positively and a healthier environment is created. Typically, a medical diagnosis is necessary to determine the cause and identify the changes required to heal the ulcer. If the cause is a medical condition, like an H. pylori infection, treatment is necessary.
How long does it take to recover?
With treatment, most peptic ulcers take a few weeks to heal. Medications are often highly effective in treating ulcers, with most people requiring medication for only about two months. For those with chronic conditions that cause ulcers, like Zollinger-Ellison syndrome, medications may be prescribed for life.
Following treatment, your gastroenterologist will conduct follow-up tests to ensure your ulcer is healing and any infection has cleared. H. pylori can come back, so it's essential to monitor your ulcer's healing progress closely. Ulcers can also return if the conditions that cause them remain unchanged.
Rarely, some ulcers may not respond to treatment, or they continue to return after treatment. These ulcers can cause chronic pain, excessive scarring, and other issues. These rare cases may require surgery to remove scar tissue to open up the outlet or sever the nerve that is triggering stomach acid.
Should I adjust my diet while living with peptic ulcer disease?
While certain foods or drinks don't cause peptic ulcers, they can certainly aggravate them. Spicy and acidic foods can be especially irritating. Alcohol and smoking can also exacerbate an ulcer and should be avoided if you're experiencing symptoms or have a history of peptic ulcer disease.
How common is peptic ulcer disease?
According to the Cleveland Clinic, approximately 5% to 10% of people globally will develop peptic ulcer disease in their lifetimes. While peptic ulcer disease is more common in middle-aged adults, it can develop at any age. Additionally, it is more common in males than females.
What is peptic ulcer disease?
Peptic ulcer disease occurs when open sores (ulcers) develop in the stomach lining or duodenum due to the protective mucous lining wearing down and exposing the tissue underneath.
Symptoms may include burning or gnawing stomach pain, bloating, belching, loss of appetite, nausea, and vomiting. It is most commonly treated with medications, but further treatment may be required if you're experiencing other serious complications like bleeding.
What are the different types of peptic ulcers?
Peptic ulcer disease most often causes two types of ulcers:
Duodenal ulcers account for approximately 80% of all peptic ulcers
Stomach ulcers account for approximately 20% of all peptic ulcers.
Peptic ulcers can develop in other areas of your gastrointestinal tract, including:
Esophageal ulcers: Caused by chronic acid reflux and stomach acid rising into your esophagus. It may erode the mucous lining in your esophagus enough to cause an ulcer. The lining in your esophagus isn’t as protected against acid as your stomach lining.
Jejunal ulcer: Ulcers can occur in your jejunum, the middle part of your small intestine, as a side effect of having your stomach connected to your jejunum through surgery (gastrojejunostomy). These can also be referred to as a stomal ulcer, marginal ulcer, or anastomotic ulcer.
What is an H. pylori infection?
H. pylori (Helicobacter pylori) is a type of bacteria that attacks your stomach and duodenum lining, causing irritation and inflammation that can lead to peptic ulcers and gastritis.
It’s the most common chronic bacterial infection in humans, affecting more than half of the world’s population. Contrary to its popularity, H. pylori bacteria don’t often cause symptoms or illness in most people.
What happens if you have H. pylori?
H. pylori bacteria can survive in the powerfully acidic environment in your stomach by producing acid-neutralizing enzymes.
This ability allows H. pylori to bury itself into the stomach lining, where it then causes inflammation and irritation. The bacteria can cause peptic ulcers, gastritis, and stomach cancer in more serious cases.
What does H. pylori poop look like?
In most cases, an H. pylori infection doesn't cause noticeable changes in your stool.
If an H. pylori infection causes peptic ulcers, bleeding in the digestive tract may occur, resulting in black, tarry, or bloody stools. If you notice any unusual changes in your stool, it's important to schedule an appointment with a gastroenterologist. You can schedule an appointment with Charleston GI today – no referral needed!
Is H. pylori contagious?
Yes, H. pylori bacteria are contagious.
The bacteria can be found in saliva, feces, and dental plaque. It can be transmitted through close contact, such as kissing, or from the hands of someone who did not thoroughly wash their hands after a bowel movement.
SCHEDULE YOUR GI APPOINTMENT TODAY, NO REFERRAL NEEDED
To learn more about treatment for GI tract issues like peptic ulcer disease, get in touch today! Charleston Gastroenterology is committed to a higher standard of caring, and we provide a range of medical treatments to help you feel your best after dealing with the irritating symptoms of a peptic ulcer.
If you are experiencing painful gastrointestinal symptoms, schedule your appointment today! No referral needed.
To learn more about treatment for GI tract issues like peptic ulcer disease, get in touch today! Charleston Gastroenterology is committed to a higher standard of caring, and we provide a range of medical treatments to help you feel your best after dealing with the irritating symptoms of a peptic ulcer.
