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peptic ulcer is a sore in the inner lining of the stomach or upper small
Ulcers form when the intestine or stomach's protective
layer is broken down. When this happens, digestive juices—which contain hydrochloric
acid and an
enzyme called pepsin—can damage the
intestine or stomach tissue.
Treatment cures most ulcers. And symptoms go away
Peptic ulcers that form in the stomach are called
gastric ulcers. Those that form in the upper small intestine are called
duodenal (say "doo-uh-DEE-nul" or "doo-AW-duh-nul") ulcers.
The two most common
causes of peptic ulcers are:
H. pylori and NSAIDs break down
the stomach or intestine's protective mucus layer.
Different people have different symptoms, and some people
have no symptoms at all.
Your doctor will
ask you questions about your symptoms and your general health, and he or she
will do a physical exam.
your symptoms aren't severe and you are younger than 55, your doctor may do
some simple tests (using your blood, breath, or stool) to look for signs of
H. pylori infection.
The only way for you
and your doctor to know for sure if you have an ulcer is to do a more
complicated test, called an
endoscopy, to look for an ulcer and to test for
H. pylori infection. An endoscopy allows the doctor to
look inside your esophagus, stomach, and small intestine. An endoscopy is
usually done by a
gastroenterologist, a doctor who specializes in
To treat peptic ulcers, most
people need to take medicines that reduce the amount of acid in the stomach. If
you have an H. pylori infection, you will also need to
help speed the healing of your ulcer and prevent it from coming back if you
quit smoking and limit alcohol. Continued use of medicines such as aspirin,
ibuprofen, or naproxen may increase the chance of your ulcer coming
Ignoring symptoms of an ulcer is not a good idea. This
condition needs to be treated. While symptoms can go away for a short time, you
may still have an ulcer. Left untreated, an ulcer can cause life-threatening
problems. Even with treatment, some ulcers may come back and may need more
Learning about peptic ulcers:
The two most common causes of
peptic ulcers are:
A rare cause
of peptic ulcers is
Zollinger-Ellison syndrome. In this condition, the
stomach makes too much acid, damaging the stomach lining.
Although there is no evidence to prove that emotional or mental stress
causes ulcers, it does seem to make ulcers worse in some people. But the
connection is still controversial.
Common ulcer symptoms include:
Less common but more serious symptoms of ulcers
Symptoms of ulcers in the upper small intestine (duodenal
ulcers) and in the stomach (gastric ulcers) are similar, except for when pain
Some ulcers don't cause symptoms. These are known as
silent ulcers. Silent ulcers are more common in:
In children, symptoms vary with age:
The symptoms of an ulcer often can be confused with
other abdominal conditions, such as
gastroesophageal reflux disease (GERD).
Many people who have
peptic ulcers may not see a doctor when
their symptoms begin. Their symptoms, such as belly pain, may come and go. Even without treatment,
some ulcers will heal by themselves.
And even with treatment,
ulcers sometimes come back. Certain factors such as cigarette smoking and continued
nonsteroidal anti-inflammatory drugs (NSAIDs) increase
the risk of ulcers coming back.
ulcers can cause complications, such as bleeding,
perforation, penetration, or obstruction. That's why it's important to treat an ulcer, even if you have one that isn't causing any symptoms.
Most peptic ulcers without complications heal, regardless of the cause.
But an ulcer is likely to come back if you have an H. pylori infection that is not successfully treated. Recurring ulcers
caused by reinfection with H. pylori are not common in
the United States, except in areas that are overcrowded or have poor
Ulcers in the stomach (gastric
ulcers) often heal more slowly than ulcers in the upper small intestine
The following things
can increase your chance of getting a
peptic ulcer and may slow the healing of an ulcer you already have:
In the past, spicy foods, caffeine, and moderate amounts of alcohol were thought to
increase ulcer risk. This is no longer believed to be
Some things that
you cannot control may increase your risk of getting an ulcer. These
If you have been diagnosed with
peptic ulcer, call 911 or other emergency services immediately if you have:
Call your doctor or seek medical attention right away if you have:
Call your doctor if you have been diagnosed with a peptic
If you have been diagnosed with a peptic ulcer
and medical treatment is not helping, call your doctor. Waiting until your
symptoms get worse can be serious.
If you don't know if you have
a peptic ulcer and you don't have any of the emergency symptoms listed above,
you may try taking an antacid or nonprescription acid reducer and other home
treatment, such as making changes to your diet.
To evaluate your symptoms, see your:
If further testing or treatment is needed,
you may need to see someone who specializes in the treatment of diseases of the
digestive tract (gastroenterologist).
If surgery is
needed, your doctor may refer you to a general surgeon. But surgery is rarely
needed to treat ulcers.
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Although not all peptic ulcers are caused by bacteria, it's getting more common to do a test for Helicobacter pylori whenever someone has ulcer
symptoms. This includes testing your blood, breath, stool, or a sample of tissue from your digestive tract (biopsy).
An endoscopy may be done so that a
If you are older than 55, you may need an endoscopy
because of a higher risk for stomach cancer. This is especially true if you have:
Other tests that may be done include:
Left untreated, many ulcers eventually
heal. But ulcers often recur if the cause of the ulcer is not eliminated or
treated. If ulcers keep coming back, you have an increased risk of developing a
serious complication, such as bleeding or a hole in the wall of your stomach or intestine.
Most of the time, treatment means taking medicines—such as H2 blockers and proton pump inhibitors (PPIs)—and making lifestyle changes, including:
If your ulcer is caused by Helicobacter pylori (H. pylori) bacteria, treatment usually involves a combination of medicines, including antibiotics.
If treatment isn't working, you may need more tests to look for bacteria. If you still have an H. pylori infection, your doctor will likely try a different combination of medicines. He or she may also suggest that you see a gastroenterologist. This specialist will do an endoscopy to look at your ulcer and to take a tissue sample (biopsy).
If you have
serious complications from a
peptic ulcer, such as bleeding or obstruction, you may
endoscopy, even if you have already had one.
stomach or intestine has a perforation or your ulcer continues to bleed despite
treatment, you may need surgery. But surgery is rarely used to treat an
You can greatly reduce the chance that you
will get a
peptic ulcer if you:
Many people who have mild ulcer symptoms first try home treatment for a short time without seeing a
But see your doctor if your symptoms don't get better after 10 to 14 days
of home treatment, or if you have other symptoms such as weight loss, nausea
after eating, or consistent pain. This is even
more important if you are middle-aged or older, because the risk for cancer or other illnesses that cause symptoms similar to peptic ulcer disease
increases with age.
Try these home treatment steps to stop
symptoms and help an ulcer heal:
Medicines are used to:
that reduce the amount of acid produced by the stomach are used to treat all
forms of peptic ulcer disease.
combination drug therapy to cure infection with
H. pylori bacteria. This usually
includes at least two antibiotics, a proton pump inhibitor, and sometimes a
Medicines used to protect the stomach from damage caused by frequent use of aspirin or other NSAIDs include:
You can get some H2 blockers and PPIs without a prescription (over the counter or OTC). If you are using OTC acid
reducers (such as Prilosec or Pepcid) to help with your symptoms for
more than 10 to 14 days at a time, or if your symptoms are very bad, be sure to see your doctor.
Surgery is rare, but it is needed sometimes to treat:
If surgery is suggested, you
may want to:
When surgery is done, it usually
involves one or more of the following:
The American College of Gastroenterology is an organization of digestive disease specialists. The website contains information about common gastrointestinal problems.
The American Gastroenterological Association is a
society of doctors who specialize in the digestive system
(gastroenterologists). This Web site can help you find a gastroenterologist in
your area. They also have patient information on many gastrointestinal diseases
This clearinghouse is a service of the U.S. National
Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the
U.S. National Institutes of Health. The clearinghouse answers questions;
develops, reviews, and sends out publications; and coordinates information
resources about digestive diseases. Publications produced by the clearinghouse
are reviewed carefully for scientific accuracy, content, and readability.
Other Works ConsultedYang YX, et al. (2006). Long-term proton pump inhibitor therapy and risk of hip fracture. JAMA, 296(24): 2947–2953.
January 4, 2012
E. Gregory Thompson, MD - Internal Medicine & Jerome B. Simon, MD, FRCPC, FACP - Gastroenterology
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