Peptic Ulcer Disease
(Stomach Ulcers · Ulcers · Gastric Ulcers · Duodenal Ulcers)
In this condition factsheet:
The Facts on Peptic Ulcer Disease
A peptic ulcer is an erosion or sore in the lining of the stomach or intestine that occurs when the protective mucus layer wears away in certain areas, allowing damage to occur from the natural acids of the stomach.
Around 10% of people will have peptic ulcer disease (PUD) at some point in their life. The majority of peptic ulcers are caused by bacteria called Helicobacter pylori (H. pylori) or by taking ASA (acetylsalicylic acid) or nonsteroidal anti-inflammatory drugs (NSAIDs; e.g., ibuprofen*, ketoprofen, naproxen).
The 2 most common types of peptic ulcers:
- Gastric ulcers are sores in the lining of the stomach.
- Duodenal ulcers are those in the first part of the small intestine, called the duodenum. This is an area where food is digested after passing through the stomach.
Causes of Peptic Ulcer Disease
Although stress and spicy foods might make the symptoms of peptic ulcer worse, they aren't the cause of the condition as was once thought.
A bacterium called H. pylori causes the majority of ulcers. The bacteria can spread into the mucus lining that usually protects the stomach and small intestine from digestive acids, damaging it in the process. By 60 years of age, up to 50% of people are infected with this bacteria, but only 10% to 20% of these people will actually develop stomach problems.
The other major cause of PUD is the use of ASA (acetylsalicylic acid) and other NSAIDs such as ibuprofen or naproxen. NSAIDs can penetrate the lining of the stomach and release substances that damage cells. NSAIDs also block natural chemicals called prostaglandins that can help to protect and repair those cells. People more at risk of ulcers caused by NSAIDs include those who:
- are seniors
- have a history of a peptic ulcer
- have a family history of peptic ulcer disease
- are also taking glucocorticoids (e.g., prednisone, dexamethasone)
- are taking high doses of NSAIDs or ASA
- have several medical conditions
- are taking more than one NSAID or ASA
- are smokers
Excessive alcohol can affect the stomach and cause it to produce more stomach acid, but it doesn’t seem to cause ulcers.
Symptoms and Complications of Peptic Ulcer Disease
The most common symptom of peptic ulcers (both duodenal and gastric) is a gnawing or burning pain in the abdomen between the breastbone and the navel, sometimes passed off as "heartburn." An ulcer can also feel like a dull ache or strong hunger pangs. Yet some people, especially the elderly and children whose ulcers were caused by NSAIDs, may not feel any pain at all from an ulcer. Ulcer pain can come or go and can be aggravated by eating or an empty stomach. Ulcers can also cause belching and bloating.
The most common complication of stomach and duodenal ulcers is bleeding. Although the blood loss is usually too slow to be noticed, it might be enough to make you tired, pale, and weak.
If bleeding from the peptic ulcer is heavier, blood may show up in the stool or vomit. Stools that have blood in them may look tarry, black, or red. If you notice any of these signs, see a doctor right away. If a bleeding ulcer is severe, it can be fatal if left untreated. Keep in mind also that, since NSAIDs are such strong painkillers, they can mask the pain of bleeding ulcers.
Very rarely, ulcers can make a hole, called a perforation, in the stomach or intestine. This can cause sudden and severe pain. Sometimes an ulcer can create a blockage out of the stomach or in the duodenum. This may cause bloating, feeling full after eating, vomiting, and weight loss.
If an ulcer causes scarring, spasm, or inflammation, it is considered a gastric outlet obstruction and may lead to weight loss and dehydration. It may cause loss of appetite with fullness after eating, or it may cause large-volume vomiting up to 6 hours after a meal.
