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This article waslast modified on November 16, 2017.
What is a peptic ulcer?

Peptic ulcers are sores that develop in the lining of the esophagus, stomach, or upper section of the small intestine (duodenum). The stomach is a strong, muscular organ that grinds and crushes food, in combination with digestive juices such as hydrochloric acid, bile acids, and enzymes, including pepsin. A mucus layer coats the interior of the stomach, protecting it from the digestive juices. Prostaglandins, hormone-like substances involved in muscle contraction, also protect the lining. Any imbalance in the production of these digestive juices can damage the lining of the stomach and form an open sore called an ulcer.

There are two types of peptic ulcers: gastric ulcers (stomach ulcer) and duodenal ulcers (first segment of the intestine).

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About Peptic Ulcers
  • Causes

    Peptic ulcers are often caused by an infection with Helicobacter pylori bacteria or use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, and naproxen.

    • Infection with H. pylori is common, especially in developing countries, with up to 50% of the world's population infected. It is believed to be transmitted by eating contaminated food or drinking water or possibly through direct contact with the stool, vomit, or saliva of an infected person. For reasons that are not yet understood, H. pylori does not cause ulcers in all who are infected; however, of those who do have peptic ulcers, more than half are caused by this infection.
    • Another common cause of peptic ulcers is long-term use of NSAIDs such as aspirin, naproxen, and ibuprofen. Individuals who take NSAIDs every day or several times a week, especially if they are age 70 or older or have had a prior ulcer, are more likely to develop peptic ulcers. Women are more likely than men to develop an ulcer due to NSAIDs.
    • Rarely, peptic ulcers can be caused by the condition Zollinger-Ellison Syndrome, in which there is increased production of the hormone gastrin due to a tumor in the pancreas or small intestine.
    • Drinking alcohol in excess and smoking can make peptic ulcers worse and prevent healing.
  • Signs and Symptoms

    The most common symptom of peptic ulcer is dull or burning pain that:

    • Occurs in the abdomen anywhere between the breast bone and the navel
    • Comes and goes over a period of time
    • May occur a few hours after eating or during the night
    • May be temporarily relieved by food and/or antacids


    Other signs and symptoms may include:

    • Loss of appetite
    • Weight loss
    • Bloating
    • Nausea, vomiting


    Symptoms that require immediate medical attention include sharp, sudden, persistent stomach pain, bloody or black (tarry) stools, or bloody vomit or vomit that looks like coffee grounds.

  • Tests

    A few different tests may be done to help diagnose a peptic ulcer, identify the cause, detect complications, and help determine appropriate treatment.

    Laboratory tests

    • One or more Helicobacter pylori tests may be performed to detect an infection.
      • A stool sample may be collected to look for the H. pylori antigen; however, this test is not appropriate for individuals who have blood in their stool.
      • A breath test known as the "urea breath test" is also available and detects the enzyme produced by H. pylori.
      • A blood test for H. pylori antibodies may be done; however, this test is not recommended by major health organizations because it cannot distinguish a current infection from a past one. If positive, additional testing is usually required.
      • Tissue biopsy – this requires a procedure called an endoscopy (see below). Tissue is removed from the stomach during the endoscopy and may be examined under a microscope for the presence of active H. pylori infection, cultured, or tested for urease, the enzyme produced by the bacteria.
    • Hemoglobin testing may be performed to check for anemia.
    • Fecal occult blood test may be done to check for blood in the stool.
    • Gastrin test may be done if someone has recurrent ulcers, to help determine the cause.


    Non-laboratory tests

    Some invasive procedures may be used to diagnose an ulcer. These include:

    • Upper GI – a series of x-rays of the gastrointestinal tract
    • Endoscopy – a tiny camera on the end of a thin tube is fed through the mouth, down the esophagus, to the duodenum; if necessary, tissue biopsies may be taken at this time.
    • Computerized tomography (CT) – uses x-rays and computers to generate images


    For more on these, see RadiologyInfo.org.

  • Treatment

    Stopping and avoiding the use of nonsteroidal anti-inflammatory drugs (NSAIDs) may help a peptic ulcer to heal. Avoidance of caffeine, alcohol, and smoking are also recommended.

    If the peptic ulcer is due to infection with Helicobacter pylori, treatment usually involves a combination of antibiotics to kill the bacteria and drugs to reduce the amount of stomach acid produced, such as proton pump inhibitors and histamine receptor blockers. A bismuth preparation such as Pepto-Bismol® may be prescribed to help coat ulcers and protect them from stomach acid.

    Treatment can take several weeks; left untreated, peptic ulcers tend to recur and, in rare cases, can cause stomach cancer. Peptic ulcers are rarely fatal, but if they penetrate the stomach or intestinal wall (perforation), break a blood vessel (hemorrhage), or block food leaving the stomach (obstruction), they can be very serious.

View Sources

NOTE: This article is based on research that utilizes the sources cited here as well as the collective experience of the Lab Tests Online Editorial Review Board. This article is periodically reviewed by the Editorial Board and may be updated as a result of the review. Any new sources cited will be added to the list and distinguished from the original sources used.

Sources Used in Current Review

Mayo Clinic. May 2013. Diseases and Conditions. Peptic Ulcer. Available online at http://www.mayoclinic.org/diseases-conditions/peptic-ulcer/basics/definition/con-20028643 through http://www.mayoclinic.org. Accessed October 13, 2014.

National Digestive Diseases Information Clearinghouse (NDDIC). Sept 2014. What I need to know about Peptic Ulcer Disease. Available online at http://digestive.niddk.nih.gov/ddiseases/pubs/pepticulcers_ez/ through http://digestive.niddk.nih.gov. Accessed October 19, 2014.

MedlinePlus. Peptic Ulcer. July 2013. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/000206.htm through http://www.nlm.nih.gov/. Accessed October 19, 2014.

American Gastroenterological Association. Understanding Peptic Ulcer Disease. 2014. Available online at http://www.gastro.org/patient-center/digestive-conditions/peptic-ulcer-disease through http://www.gastro.org. Accessed October 19, 2014.

Santacroce, L. and Bhutani, M. (Updated 2014 September 11). Helicobacter Pylori Infection. Medscape Drugs & Diseases [On-line information]. Available online at http://emedicine.medscape.com/article/176938-overview through http://emedicine.medscape.com. Accessed October 2014.

Pagana, K., and Pagana T. Mosby's Diagnostic and Laboratory Test Reference, 11th edition. 2012. Edinburgh: Mosby.

Source Used in Previous Reviews

National Digestive Diseases Information Clearinghouse. H. pylori and Peptic Ulcer. Available online at http://digestive.niddk.nih.gov/ddiseases/pubs/hpylori/ through http://digestive.niddk.nih.gov. Accessed August 2008.

American Academy of Family Physicians. Ulcers and H. pylori Infection. (Updated December 2006). Available online at http://familydoctor.org/online/famdocen/home/common/digestive/disorders/271.html through http://familydoctor.org. Accessed August 2008.

American Gastroenterological Association. Peptic Ulcer Disease, Ulcer Fact Sheet. Available online at http://www.gastro.org/wmspage.cfm?parm1=857 through http://www.gastro.org. Accessed August 2008.

Henry's Clinical Diagnosis and Management by Laboratory Methods. 21st ed. McPherson R, Pincus M, eds. Philadelphia, PA: Saunders Elsevier: 2007 pp279-280.

Abdul Nadir, MD. Chief, Gastroenterology. Maricopa Medical Center, Phoenix, AZ.

MedlinePlus Medical Encylopedia. Peptic ulcer. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/000206.htm#Signs%20and%20tests. Accessed June 2011.

National Digestive Diseases Information Clearinghouse. H. pylori and Peptic Ulcers. Available online at http://digestive.niddk.nih.gov/ddiseases/pubs/hpylori/ through http://digestive.niddk.nih.gov. Accessed June 2011.

MayoClinic.com. Peptic ulcer. Available online at http://www.mayoclinic.com/health/peptic-ulcer/DS00242 through http://www.mayoclinic.com. Accessed June 2011.

American Gastroenterological Association. Understanding Peptic Ulcer Disease. Available online at http://www.gastro.org/patient-center/digestive-conditions/peptic-ulcer-disease through http://www.gastro.org. Accessed June 2011.