Peptic Ulcer Disease: Causes, Symptoms, and Treatment
Peptic ulcer disease means open sores (ulcers) in the lining of the stomach (gastric ulcers) or the first part of the small intestine (duodenal ulcers). Most ulcers heal with treatment, and treating the cause keeps them from coming back.
Symptoms
- Burning or gnawing pain in the upper belly, which may improve or worsen with eating
- Bloating, fullness, and burping
- Nausea and loss of appetite
- Heartburn
Some ulcers, especially from NSAIDs, cause no pain until they bleed.
Go to the emergency room for black or tarry stools, vomiting blood or "coffee grounds," dizziness or fainting, or sudden severe belly pain. These can be signs of bleeding or a perforated (torn) ulcer.
Causes
- H. pylori infection, a common stomach bacterium
- NSAIDs: ibuprofen (Advil, Motrin), naproxen (Aleve), and aspirin, even low-dose aspirin
- Less common: steroids or blood thinners taken with NSAIDs, some osteoporosis medicines (bisphosphonates), severe illness, and Zollinger-Ellison syndrome (a rare tumor that causes too much acid)
Risk factors
- Older age
- Regular or high-dose NSAID use, especially with blood thinners or steroids
- A past ulcer
- Smoking and heavy alcohol use, which also slow healing
Diagnosis
- Upper endoscopy (EGD): the best test. A thin camera examines the esophagus, stomach, and duodenum, biopsies check for H. pylori and cancer, and bleeding ulcers can be treated during the procedure.
- H. pylori testing by breath, stool, or biopsy.
- Upper GI X-ray series (barium swallow): used less often today because it can miss small ulcers.
Treatment options
Heal the ulcer
- Proton pump inhibitors (PPIs) such as omeprazole, pantoprazole, or esomeprazole, usually for 4 to 8 weeks
- H2 blockers such as famotidine, for milder cases
- Sucralfate, which coats and protects the ulcer
Treat the cause
- H. pylori: antibiotics plus an acid reducer for 14 days, then a test to confirm the infection is gone
- NSAIDs: stop them if possible and use acetaminophen (Tylenol) for pain. If you must take an NSAID or aspirin, your doctor may prescribe a PPI to protect your stomach.
- Stop smoking and limit alcohol
Treat complications
- Bleeding: during endoscopy, the doctor can stop bleeding with clips, heat, or injections. Some patients need a hospital stay and IV acid-blocking medicine.
- Perforation or blockage: may need surgery or endoscopic treatment.
Follow-up
For a stomach ulcer, your doctor may repeat the endoscopy in 8 to 12 weeks to confirm it has healed and is not cancer. Call us if symptoms return or new symptoms appear. See also gastritis and GI bleeding.
Make an appointment
Our gastroenterologists in Temple City care for patients from Arcadia, San Gabriel, Pasadena, Monrovia, Monterey Park, and across the San Gabriel Valley. We accept most PPO plans (see accepted insurances), and our doctors speak English, Vietnamese, and Mandarin. Schedule an appointment or call 626-898-4560.
This article is for general education and is not a substitute for medical advice. Talk with your doctor about your own health.
Quick Answers
What causes peptic ulcers?
Most are caused by H. pylori infection or by NSAID pain relievers such as ibuprofen, naproxen, and aspirin. Smoking and alcohol slow healing.
How are ulcers treated?
With an acid-reducing medicine, usually a proton pump inhibitor (PPI) for 4 to 8 weeks, plus treating the cause: antibiotics for H. pylori and stopping NSAIDs.
What are the warning signs of a bleeding ulcer?
Black, tarry stools, vomiting blood or material that looks like coffee grounds, dizziness or fainting, and sudden severe belly pain. These need emergency care.
Will I need another endoscopy?
For a stomach (gastric) ulcer, your doctor may repeat the endoscopy in 8 to 12 weeks to confirm healing and make sure it is not cancer. Duodenal ulcers usually do not need a repeat exam if symptoms resolve.
Can I take NSAIDs after an ulcer?
It is best to avoid them. If you must take one, your doctor may recommend the lowest dose for the shortest time along with a PPI, or a different pain reliever such as acetaminophen.
