Peptic Ulcers: Symptoms, Causes, Warning Signs and Treatment

A peptic ulcer is a sore in the lining of the stomach or of the duodenum, the first part of the small intestine. Ulcers form when the acids that help digest food damage the wall of the stomach or duodenum.

Symptoms

The most common symptom is pain in the upper abdomen, anywhere between the belly button and the breastbone. It may be dull or burning, and it may:

• start between meals or during the night;
• stop briefly after eating or taking antacids — though for some people eating makes it worse;
• last from minutes to hours;
• come and go over several days or weeks.

Other symptoms of indigestion can include feeling full too soon during a meal or uncomfortably full after one, nausea and vomiting, bloating and belching. Many people with a peptic ulcer have no symptoms until the ulcer causes a complication.

Get care right away for

• black or tarry stool, or red or maroon blood mixed with stool;
• red blood in vomit, or vomit that looks like coffee grounds;
• sudden, sharp or severe abdominal pain that does not go away;
• dizziness or fainting;
• a rapid pulse or other signs of shock;
• a change in, or worsening of, ulcer symptoms.

Causes

The most common cause is infection with the bacterium Helicobacter pylori (H. pylori). It may spread from person to person through contact with an infected person's vomit, stool or saliva, or through food or water contaminated with them.

The other common cause is nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen and naproxen, especially:

• taken for a long time, in high doses, or more than one at once;
• of a type more likely to cause ulcers;
• together with other medicines that raise the risk, or alongside an H. pylori infection.

Stress and spicy food do not cause ulcers, but they can make them worse.

Diagnosis

To check for H. pylori, a doctor tests your blood, breath or stool. They may also look inside the stomach and duodenum with an endoscopy or an X-ray.

Treatment

Untreated, peptic ulcers get worse. Doctors prescribe medicines to help the ulcer heal, including medicines that reduce stomach acid — among them proton pump inhibitors (PPIs) and H2 blockers — and treat the cause:

• H. pylori is treated with a combination, usually two or more antibiotics and a PPI, sometimes with bismuth subsalicylate. Take every dose exactly as prescribed: stopping early can let bacteria survive and become resistant. A test at least 4 weeks after finishing the antibiotics shows whether the infection is gone.
• NSAIDs. Your doctor may suggest stopping them, switching to a different or lower-dose NSAID, or another pain medicine; if you must keep taking an NSAID, a PPI may be added.

Antacids and milk cannot heal a peptic ulcer. Not smoking — smoking slows healing — and avoiding alcohol can help. An ulcer that does not heal may need further tests, more medicine, or surgery.

Sources

• MedlinePlus, U.S. National Library of Medicine, "Peptic Ulcer," drawing on the National Institute of Diabetes and Digestive and Kidney Diseases. https://medlineplus.gov/pepticulcer.html
• National Institute of Diabetes and Digestive and Kidney Diseases, "Symptoms & Causes of Peptic Ulcers" and "Treatment for Peptic Ulcers." https://www.niddk.nih.gov/health-information/digestive-diseases/peptic-ulcers-stomach-ulcers
• Rewritten in hubnx's own words.