A peptic ulcer is a defect in the lining of the stomach or the first part of the small intestine, an area called the duodenum.
A peptic ulcer in the stomach is called a gastric ulcer. An ulcer in the duodenum is called a duodenal ulcer.
Normally, the lining of the stomach and small intestines is protected against the irritating acids produced in your stomach. If this protective lining stops working correctly and the lining breaks down, it results in inflammation (gastritis) or an ulcer.
Most ulcers occur in the first layer of the inner lining. A hole that goes all the way through the stomach or duodenum is called a perforation. A perforation is a medical emergency.
The most common cause of such damage is infection of the stomach by bacteria called Helicobacter pylori (H.pylori). Most people with peptic ulcers have these bacteria living in their gastrointestinal (GI) tract. Yet, many people who have these bacteria in their stomach do not develop an ulcer.
The following also raise your risk for peptic ulcers:
A rare condition called Zollinger-Ellison syndrome causes stomach and duodenal ulcers. Persons with this disease have a tumor in the pancreas. This tumor releases high levels of a hormone that increases stomach acid.
Many people believe that stress causes ulcers. It is not clear if this is true, at least for everyday stress at home.
Small ulcers may not cause any symptoms. Some ulcers can cause serious bleeding.
Abdominal pain is a common symptom, but it doesn't always occur. The pain can differ from person to person.
Other symptoms include:
Other possible symptoms include:
To diagnose an ulcer, your doctor will order one of the following tests:
Upper endoscopy is also done on people who are at high risk for stomach cancer. Risk factors include being over age 45 or having symptoms such as:
Testing for H. pylori is also needed.
Your doctor may also order these tests:
Treatment involves a combination of medications to kill the H. pylori bacteria (if present), and reduce acid levels in the stomach. This strategy allows your ulcer to heal and reduces the chance it will come back.
Take all of your medications exactly as prescribed.
If you have a peptic ulcer with an H. pylori infection, the standard treatment uses different combinations of the following medications for 5 - 14 days:
If you have an ulcer without an H. pylori infection, or one that is caused by taking aspirin or NSAIDs, your doctor will likely prescribe a proton pump inhibitor for 8 weeks.
You may also be prescribed this type of medicine if you must continue taking aspirin or NSAIDs for other health conditions.
Other medications that may be used for ulcer symptoms or disease are:
If a peptic ulcer bleeds a lot, an EGD may be needed to stop the bleeding. Methods used to stop the bleeding include injecting medicine, or applying metal clips to the ulcer. Surgery may be needed if bleeding cannot be stopped with an EGD, or if the ulcer has caused a tear (perforation).
Peptic ulcers tend to come back if untreated. If you follow your doctor's treatment instructions and take all of your medications as directed, the H. pylori infection will likely be cured and you'll be much less likely to get another ulcer.
Seek urgent help if you:
Call your doctor if:
Avoid aspirin, ibuprofen, naproxen, and other NSAIDs. Try acetaminophen instead. If you must take such medicines, talk to your doctor first. Your doctor may:
The following lifestyle changes may help prevent peptic ulcers:
Ulcer - peptic; Ulcer - duodenal; Ulcer - gastric; Duodenal ulcer; Gastric ulcer; Dyspepsia - ulcers
Chan FKL, Lau JYW. Peptic ulcer disease. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 53.
Chey WD, Wong BC. American College of Gastroenterology guideline on the management of Helicobacter pylori infection. Am J Gastroenterol. 2007;102:1808-1825.
Lanza FL, Chan FK, Quigley EM; Practice Parameters Committee of the American College of Gastroenterology. Guidelines for prevention of NSAID-related ulcer complications. Am J Gastroenterol. 2009;104:728-738.
McColl KEL. Helicobacter pylori infection. NEJM. 2010;362:1597-1604.
Updated by: George F. Longstreth, MD, Department of Gastroenterology, Kaiser Permanente Medical Care Program, San Diego, California. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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