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 lining 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 main types of peptic ulcers: gastric ulcers (stomach ulcer) and duodenal ulcers (first segment of the intestine). Rarely, peptic ulcers can form in the esophagus, just above the stomach.
About Peptic Ulcers
- About 30% to 40% of Americans and nearly 50% of the world’s population carries H. pylori in their digestive tracts. H. pylori is thought to be spread through contaminated food or drinking water or possibly through contact with body fluids (e.g., saliva) from an infected person, but the source of the infection remains unknown. For reasons that are not yet understood, H. pylori does not cause ulcers in most people. It can remain dormant in your digestive tract without causing signs or symptoms for many years. However, in people who do have peptic ulcers, more than half have H. pylori 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. Also, people who have two or more medical conditions or take other medicines are more likely to develop a peptic ulcer caused by 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.
Other factors may play a role in the development of peptic ulcers or can make them worse. Examples include:
- Drinking alcohol in excess
- Eating spicy foods
Signs and Symptoms
Many people with peptic ulcers do not experience any symptoms. However, 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 time
- May occur a few hours after eating or during the night, but often occurs when the stomach is empty
- May be temporarily relieved by food and/or antacids
- Loss of appetite
- Unintended weight loss
- 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.
A few different tests may be done to help diagnose a peptic ulcer, identify the cause, detect complications, and help determine appropriate treatment.
One or more Helicobacter pylori tests may be performed to detect an infection:
The stool antigen test and urea breath test are recommended for the diagnosis of an H. pylori infection and for the evaluation of the effectiveness of treatment. These tests are the most frequently performed tests because they are fast and noninvasive. (The urea breath test is not typically recommended for young children. In children, the preferred test would be the stool antigen test.)
Some tests involve endoscopy, the use of a small, flexible tube with a light and a camera to view your upper digestive track. A sample of tissue may be removed from your digestive tract (biopsied) during endoscopy. These tests are less frequently performed because they are invasive.
The following tables summarize these tests:
|Stool/fecal antigen test||Detects the presence of H. pylori antigen in a stool sample|
|Urea breath test||
|Histology||A pathologist examines a sample of tissue using a microscope to look for H. pylori bacteria and any other signs of disease that may explain your symptoms.|
|Rapid urease testing||H. pylori produces urease, an enzyme that allows it to survive in the acidic environment of the stomach. The laboratory test can detect urease in the tissue sample.|
|Culture||The bacteria are grown on/in a nutrient media; results can take several weeks. This test is necessary if your healthcare practitioner wants to evaluate which antibiotic will likely cure your infection. (See also Antibiotic Susceptibility Testing.)|
|PCR (polymerase chain reaction)||Detects H. pylori DNA; primarily used in research settings|
H. pylori antibody test—the American Gastroenterology Association, the American College of Gastroenterologists, the Infectious Diseases Society of America, and the American Society for Microbiology do not recommend the antibody blood test for routine use in diagnosing an H. pylori infection or evaluating its treatment as the test cannot distinguish between a present and previous infection. A few healthcare practitioners still order this test, but many laboratories have stopped offering it. If the test is performed and the result is negative, then it is unlikely that you have had an H. pylori infection. If it is positive, then a stool antigen or breath test should be used to confirm that you have a current H. pylori infection.
Other general laboratory tests may include:
- 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 you have recurrent ulcers, to help determine the cause
Some invasive procedures may be used to diagnose an ulcer. These include:
- EsophagoGastroDuodenoscopy (EGD)/Upper endoscopy—a tiny camera on the end of a thin tube is fed through the mouth, down the esophagus, to the first part of the small intestine (duodenum). If necessary, tissue biopsies may be taken at this time. This is the most common way a peptic ulcer is diagnosed. (For details, see the MedlinePlus article on EGD).
- Computerized tomography (CT)—uses x-rays and computers to generate images; for more on this, see RadiologyInfo.org.
The treatment for a peptic ulcer depends on the cause.
Ulcers caused by H. pylori require treatment with antibiotics to clear the infection.
Almost all ulcers are treated with a proton pump inhibitor (PPI) to reduce the production of acid by the stomach lining. Duodenal ulcers will sometimes be treated with H2 blockers, which also reduce acid.
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.
Treatment can take several weeks. Left untreated, peptic ulcers tend to come back 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 and cause bleeding, or block food from leaving the stomach (obstruction), they can be very serious and may require surgery.
For more details about treatment, see the resources in the Related Content section.
Sources Used in Current Review
Peptic Ulcer Disease Overview. American Gastroenterological Association. Available online at https://www.gastro.org/practice-guidance/gi-patient-center/topic/peptic-ulcer-disease. Accessed September 2019.
Peptic Ulcer Disease-an Overview. American College of Gastroenterology. Available online at https://gi.org/topics/peptic-ulcer-disease/. Accessed September 2019.
[November 2014] Definition & Facts for Peptic Ulcers (Stomach Ulcers). National Institute of Diabetes and Digestive and Kidney Diseases. Available online at https://www.niddk.nih.gov/health-information/digestive-diseases/peptic-ulcers-stomach-ulcers/definition-facts. Accessed September 2019.
[December 2018] Peptic Ulcer. Harvard Medical School. Available online at https://www.health.harvard.edu/a_to_z/peptic-ulcer-a-to-z. Accessed September 2019.
[August 8, 2018] Helicobacter Pylori Infection. Medscape. Available online at https://emedicine.medscape.com/article/176938-overview. Accessed September 2019.
[November 2019] What is H. pylori? WebMD. Available online at https://www.webmd.com/digestive-disorders/h-pylori-helicobacter-pylori#1. Accessed September 2019.
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/. 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. Accessed August 2008.
American Gastroenterological Association. Peptic Ulcer Disease, Ulcer Fact Sheet. Available online at http://www.gastro.org/wmspage.cfm?parm1=857. 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/. Accessed June 2011.
MayoClinic.com. Peptic ulcer. Available online at http://www.mayoclinic.com/health/peptic-ulcer/DS00242. Accessed June 2011.
American Gastroenterological Association. Understanding Peptic Ulcer Disease. Available online at http://www.gastro.org/patient-center/digestive-conditions/peptic-ulcer-disease. Accessed June 2011.
Mayo Clinic. May 2013. Diseases and Conditions. Peptic Ulcer. Available online at http://www.mayoclinic.org/diseases-conditions/peptic-ulcer/basics/definition/con-20028643. 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/. Accessed October 19, 2014.
MedlinePlus. Peptic Ulcer. July 2013. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/000206.htm. 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. 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. Accessed October 2014.
Pagana, K., and Pagana T. Mosby’s Diagnostic and Laboratory Test Reference, 11th edition. 2012. Edinburgh: Mosby.