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Diseases & Conditions

Peptic Ulcer Disease

Peptic ulcer disease refers to painful sores or ulcers in the lining of the stomach or the first part of the small intestine, the duodenum.

Normally, a thick layer of mucus protects the stomach lining from the effect of its digestive juices. But many things can reduce this protective layer, allowing for ulcers to occur.

What causes ulcers?

No single cause has been found for ulcers. However, it is now clear that an ulcer is the end result of an imbalance between digestive fluids (hydrochloric acid and pepsin, a digestive enzyme) in the stomach and duodenum. Ulcers can be caused by:

  • Infection with a type of bacteria called Helicobacter pylori (H. pylori)
  • Use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, naproxen (Aleve®, Anaprox®, Naprosyn®, and others), ibuprofen (Motrin®, Advil®, Midol®, and others), and many others available by prescription. Even aspirin coated with a special substance can still cause ulcers.
  • Excess acid production from Zollinger-Ellison syndrome (gastrinoma). A gastrinoma is a tumor of the acid producing cells of the stomach that increases acid output.

Can spicy foods cause ulcers?

Though spicy foods can make ulcers more painful, they are not known to cause ulcers.

What symptoms should I look for?

An ulcer may or may not have symptoms. When symptoms occur, they include:

  • A gnawing or burning pain in the middle or upper stomach between meals or at night
  • Bloating
  • Heartburn
  • Nausea or vomiting

In severe cases symptoms can include:

  • Dark or black stool (due to bleeding)
  • Vomiting
  • Weight loss
  • Severe pain in the mid to upper abdomen

Am I at increased risk if I take NSAIDs regularly?

The risk is dose-related (meaning the more you take, the greater the risk) and increases with:

  • Age (more likely over age 60)
  • Gender (occurs more often in women than men)
  • Use of corticosteroids, such as those taken for asthma or lupus and NSAIDs together
  • Length of time taking NSAIDs
  • A history of ulcer disease

How serious is this condition?

Though ulcers often heal on their own, you shouldn't ignore their warning signs. If not properly treated, ulcers can lead to serious health problems, including:

  • Bleeding
  • Perforation (a hole through the wall of the stomach)
  • Gastric outlet obstruction( from swelling or scarring )that blocks the passageway leading from the stomach to the small intestine

Taking NSAIDs can cause any of the above without warning. The risk is especially concerning for those over age 75 and for those with a prior history of having peptic ulcer disease.

Who is more likely to get ulcers?

You may be more likely to develop ulcers if you:

  • Are infected with the H. pylori bacterium
  • Take NSAIDs such as aspirin, ibuprofen, naproxen, and many others
  • Have a family history of ulcers
  • Smoke
  • Have another illness, such as liver, kidney, or lung disease
  • Drink alcohol regularly

How are ulcers diagnosed?

Your doctor may be able to make the diagnosis just by talking with you about your symptoms. However, to confirm the diagnosis one of several tests should be taken. First, your doctor may ask you to take an acid-blocking medication for a short period of time to see if your symptoms improve.

If needed, your doctor may recommend a procedure called an upper endoscopy. It involves inserting a small, lighted tube (endoscope) through the throat and into the stomach to look for abnormalities. This procedure is usually given if you are having severe symptoms of ulcers.

Often, doctors will frequently treat without confirming the diagnosis using endoscopy. If the cause is not likely to be from NSAIDs, then it is very likely to be from H. pylori. Most doctors will now test for H. pylori and will treat specifically for that in addition to giving medications to reduce the symptoms.

H. pylori can be detected either directly by taking a sample during the upper endoscopy described above or indirectly with a blood test or a breath test.

Though ulcers often heal on their own, you shouldn't ignore their warning signs. If not properly treated, ulcers can lead to serious health problems.

How are ulcers treated?

There are several ways in which ulcers can be treated, including making changes to one's lifestyle, taking medication, and/or undergoing surgery.


To treat an ulcer, first eliminate substances that can be causing the ulcers. If you smoke or drink alcohol, stop. If the ulcer is believed to be caused by the use of NSAIDs, they need to be stopped.

  • Proton pump inhibitors (PPI). Proton pump inhibitors reduce acid and allow the ulcer to heal. PPIs include Prilosec®, Prevacid®, Aciphex®, Protonix®, and Nexium®.
  • Antibiotics. Antibiotics are used to treat H. pylori. There are multiple combinations of antibiotics that are taken for one to two weeks along with a PPI. Some doctors also recommend taking Pepto-Bismol®.

Some bleeding ulcers can be treated through the endoscope.


An operation may be needed if the ulcer has created a hole in the stomach wall or if there is serious bleeding.

Will drinking milk help cure an ulcer?

No. Milk can make your ulcer worse. Milk provides brief relief of ulcer pain because it coats the stomach lining. But milk also stimulates your stomach to produce more acid and digestive juices, which can aggravate ulcers.

How can I prevent ulcers?

  • If you smoke, quit. People who smoke are twice as likely to develop ulcers. Ulcers also heal more slowly in people who smoke.
  • Avoid overindulging in alcohol.
  • If you have symptoms of an ulcer, contact your doctor.
  • Don't overuse NSAIDs.

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 9/16/2012...#10350

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