Peptic Ulcer

(PUD; Duodenal Ulcer; Ulcer, Peptic; Ulcer, Duodenal)

Definition

A peptic ulcer is a sore in the lining of the stomach or intestine. They may be named by their location:

Gastric Ulcer

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Causes    TOP

Acids that help you break down food can lead to an ulcer. A change to the amount of acid causes damage to the stomach or intestine walls. This is most often caused by:

  • Helicobacter pylori (H. pylori) infection
  • Nonsteroidal anti-inflammatory drugs (NSAIDs)

Less common causes include:

Risk Factors    TOP

Factors that may increase the chances of a peptic ulcer include:

  • Taking NSAIDs for a long time and at higher doses
  • Prior peptic ulcer disease
  • Cigarette smoking
  • Alcohol use disorder

Symptoms    TOP

Peptic ulcers do not always cause symptoms. Symptoms may come and go. Food or fluids may make symptoms better and an empty stomach may make them worse.

Symptoms may include:

  • Burning stomach pain that:
    • May awaken you from sleep
    • Is worse on an empty stomach
    • Can be relieved with food or antacids
  • Feeling of fullness
  • Bloating
  • Nausea
  • Vomiting
  • Burping
  • Loss of appetite
  • Heartburn

Ulcers can cause bleeding. It is rare but heavier bleeding can cause:

  • Bloody or black, tarry stools
  • Vomiting what looks like coffee grounds or blood

Diagnosis    TOP

The doctor will ask about your symptoms and past health. A physical exam will be done. The doctor may suspect an ulcer based on your symptoms.

An endoscopy will help to make the diagnosis. A scope will be passed down the throat to view the lining of the stomach.

Other tests may include:

  • H. pylori test—may be done through blood, stool, or a breath test
  • Biopsy—sample of tissue is removed to look for cause

Treatment    TOP

Treatment will depend on the cause. General steps include:

  • Stopping further damage by decreasing stomach acid
  • Allowing time for ulcer to heal

Medicine

Stomach acid can be managed with:

  • Proton pump inhibitors (PPI)—decrease production of acid
  • H2 blockers—if PPIs aren't effective
  • Over-the-counter antacids—neutralizes stomach acid

Medicine related to causes include:

  • Stop or limit NSAIDS—doctor may switch to another medicine if needed
  • Antibiotics to treat H. pylori infection

Quit smoking. Smoking worsens symptoms and slows healing.

Surgery and Endoscopy

An endoscopy may help to stop small areas of bleeding.

Surgery may be needed for:

  • An ulcer that won't heal
  • Ulcers that return often
  • Severe bleeding
  • A perforation—sore has passed all the way through stomach wall (emergency surgery)
  • Problems passing food out of the stomach

There are different types of surgery. Options include:

  • Removal of the ulcer
  • Removal of part of the stomach or small intestine
  • Tying off the bleeding blood vessel
  • A section of healthy tissue is removed and sewn over the ulcer
  • Cut nerve that is linked to acid production

Prevention    TOP

To help reduce the chances of H. pylori infection:

  • Wash your hands often. This is important after using the bathroom and before eating or making food.
  • Drink water from a safe source.
  • Do not smoke. Smoking increases the chances of getting an ulcer.

To help reduce the chances of a peptic ulcer from NSAIDs:

  • Use other drugs when possible for managing pain.
  • Take the lowest possible dose.
  • Do not take drugs longer than needed.
  • Do not drink alcohol while taking the drugs.
  • Do not smoke. Smoking increases the chances of getting an ulcer.

RESOURCES:

American College of Gastroenterology
http://patients.gi.org
American Gastroenterological Association
http://www.gastro.org

CANADIAN RESOURCES

Canadian Association of Gastroenterology
https://www.cag-acg.org
Canadian Digestive Health Foundation
http://www.cdhf.ca

References:

Fashner J, Gitu AC. Diagnosis and treatment of peptic ulcer disease and H. pylori infection. Am Fam Physician. 2015;91(4):236-242.
Peptic ulcer disease. American College of Gastroenterology website. Available at:
...(Click grey area to select URL)
Accessed April 4, 2018.
Peptic ulcer disease. American Gastroenterological Association website. Available at:
...(Click grey area to select URL)
Updated July 2017. Accessed April 4, 2018.
Peptic ulcer disease. EBSCO DynaMed Plus website. Available at: http://www.dynamed.... Updated April 2, 2018. Accessed April 4, 2018.
Peptic ulcers (stomach ulcers). National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: https://www.niddk.nih.gov/health-information/digestive-diseases/peptic-ulcers-stomach-ulcers. Accessed April 4, 2018.
Last reviewed April 2018 by EBSCO Medical Review Board Daus Mahnke, MD
Last Updated: 8/31/2018

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