Peptic Ulcer Disease
What is peptic ulcer disease?
Peptic ulcer disease is a condition in which painful sores or ulcers develop 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 stomach acid to damage the tissue.
Who is more likely to get ulcers?
One in 10 people develops an ulcer. Risk factors that make ulcers more likely include:
- Frequent use of nonsteroidal anti-inflammatory drugs (NSAIDs), a group of common pain relievers that includes ibuprofen (Advil® or Motrin®).
- A family history of ulcers.
- Illness such as liver, kidney or lung disease.
- Regularly drinking alcohol.
Symptoms and Causes
What causes ulcers?
People used to think that stress or certain foods could cause ulcers. But researchers haven’t found any evidence to support those theories. Instead, studies have revealed two main causes of ulcers:
H. pylori bacteria
H. pylori commonly infects the stomach. About 50% of the world’s population has an H. pylori infection, often without any symptoms. Researchers believe people can transmit H. pylori from person to person, especially during childhood.
The H. pylori bacteria stick to the layer of mucus in the digestive tract and cause inflammation (irritation), which can cause this protective lining to break down. This breakdown is a problem because your stomach contains strong acid intended to digest food. Without the mucus layer to protect it, the acid can eat into stomach tissue.
However, for most people the presence of H. pylori doesn’t have a negative impact. Only 10% to 15% of people with H. pylori end up developing ulcers .
Another major cause of peptic ulcer disease is the use of NSAIDs, a group of medications used to relieve pain. NSAIDS can wear away at the mucus layer in the digestive tract. These medications have the potential to cause peptic ulcers to form:
- Aspirin (even those with a special coating).
- Naproxen (Aleve®, Anaprox®, Naprosyn® and others).
- Ibuprofen (Motrin®, Advil®, Midol® and others).
- Prescription NSAIDs (Celebrex®, Cambia® and others).
Acetaminophen (Tylenol®) is not an NSAID and won’t cause damage to your stomach. People who can’t take NSAIDs are often directed to take acetaminophen.
Not everyone who takes NSAIDs will develop ulcers. NSAID use coupled with an H. pylori infection is potentially the most dangerous. People who have H. pylori and who frequently use NSAIDs are more likely to have damage to the mucus layer, and their damage can be more severe. Developing an ulcer from NSAID use also increases if you:
- Take high doses of NSAIDs.
- Are 70 years or older.
- Are female.
- Use corticosteroids (drugs your doctor might prescribe for asthma, arthritis or lupus) at the same time as taking NSAIDs.
- Use NSAIDS continuously for a long time.
- Have a history of ulcer disease.
Infrequently, other situations cause peptic ulcer disease. People may develop ulcers after:
- Being seriously ill from various infections or diseases.
- Having surgery.
- Taking other medications, such as steroids.
Peptic ulcer disease can also occur if you have a rare condition called Zollinger-Ellison syndrome (gastrinoma). This condition forms a tumor of acid-producing cells in the digestive tract. These tumors can be cancerous or noncancerous. The cells produce excessive amounts of acid that damages stomach tissue.
Can coffee and spicy foods cause ulcers?
It’s a common misconception that coffee and spicy foods can cause ulcers. In the past, you might have heard that people with ulcers should eat a bland diet. But now we know that if you have an ulcer, you can still enjoy whatever foods you choose as long as they don’t make your symptoms worse.
What are some ulcer symptoms?
Some people with ulcers don’t experience any symptoms. But signs of an ulcer can include:
- Gnawing or burning pain in your middle or upper stomach between meals or at night.
- Pain that temporarily disappears if you eat something or take an antacid.
- Nausea or vomiting.
In severe cases, symptoms can include:
- Dark or black stool (due to bleeding).
- Weight loss.
- Severe pain in your mid- to upper abdomen.
Diagnosis and Tests
How are ulcers diagnosed?
Your healthcare provider may be able to make the diagnosis just by talking with you about your symptoms. If you develop an ulcer and you’re not taking NSAIDs, the cause is likely an H. pylori infection. To confirm the diagnosis, you’ll need one of these tests:
If you have severe symptoms, your provider may recommend an upper endoscopy to determine if you have an ulcer. In this procedure, the doctor inserts an endoscope (a small, lighted tube with a tiny camera) through your throat and into your stomach to look for abnormalities.
H. Pylori tests
Tests for H. pylori are now widely used and your provider will tailor treatment to reduce your symptoms and kill the bacteria. A breath test is the easiest way to discover H. pylori. Your provider can also look for it with a blood or stool test, or by taking a sample during an upper endoscopy.
Less frequently, imaging tests such as X-rays and CT scans are used to detect ulcers. You have to drink a specific liquid that coats the digestive tract and makes ulcers more visible to the imaging machines.
Management and Treatment
Will ulcers heal on their own?
Though ulcers can sometimes heal on their own, you shouldn't ignore the warning signs. Without the right treatment, ulcers can lead to serious health problems, including:
- Perforation (a hole through the wall of the stomach).
- Gastric outlet obstruction (from swelling or scarring) that blocks the passageway from the stomach to the small intestine.
What ulcer treatments are available?
If your ulcer is bleeding, your doctor may treat it during an endoscopy procedure by injecting medications into it. Your doctor could also use a clamp or cauterization (burning tissue) to seal it off and stop the bleeding.
For most people, doctors treat ulcers with medications, including:
- Proton pump inhibitors (PPI): These drugs reduce acid, which allows the ulcer to heal. PPIs include Prilosec®, Prevacid®, Aciphex®, Protonix® and Nexium®.
- Histamine receptor blockers (H2 blockers): These drugs also reduce acid production and include Tagamet®, Pepcid®, Zantac® and Axid®.
- Antibiotics: These medications kill bacteria. Doctors use them to treat H. pylori.
- Protective medications: Like a liquid bandage, these medications cover the ulcer in a protective layer to prevent further damage from digestive acids and enzymes. Doctors commonly recommend Carafate® or Pepto-Bismol®.
How can I prevent ulcers?
You may be able to prevent ulcers from forming if you:
- Talk to your doctor about alternatives to NSAID medications (like acetaminophen) to relieve pain.
- Discuss protective measures with your doctor, if you can’t stop taking an NSAID.
- Opt for the lowest effective dose of NSAID and take it with a meal.
- Quit smoking.
- Drink alcohol in moderation, if at all.
Outlook / Prognosis
Are ulcers curable?
For most people, treatment that targets the underlying cause (usually H. pylori bacterial infection or NSAID use) is effective at eliminating peptic ulcer disease. Ulcers can reoccur, though, especially if H. pylori isn’t fully cleared from your system or you continue to smoke or use NSAIDs.
How long does it take an ulcer to heal?
It generally takes several weeks of treatment for an ulcer to heal.
Will drinking milk help an ulcer?
No. Milk may temporarily soothe ulcer pain because it coats the stomach lining. But milk also causes your stomach to produce more acid and digestive juices, which can make ulcers worse.
Is it safe to take antacids?
Antacids temporarily relieve ulcer symptoms. However, they can interfere with the effectiveness of prescribed medications. Check with your doctor to find out if antacids are safe to take while undergoing treatment.
What should ulcer patients eat?
No foods have been proven to negatively or positively impact ulcers. However, eating a nutritious diet and getting enough exercise and sleep is good for your overall health.
What questions should I ask my doctor?
If you have stomach ulcers, you may want to ask your doctor:
- What pain reliever can I use instead of an NSAID?
- How will I know if the H. pylori infection is gone?
- How do we find out if the ulcer has healed?
- What can I do relieve symptoms at home during treatment?
A note from Cleveland Clinic
Contrary to commonly held beliefs, ulcers aren’t caused by stress or foods you eat. Most of time, bacteria causes them. Doctors can treat the bacteria with antibiotics and other medications.
If you’ve been popping a lot of antacids lately, you’re constantly snacking to get rid of a gnawing pain in your stomach or you have any other signs of an ulcer, the best thing you can do for your health is talk to your provider. Treatment can heal an ulcer in a matter of weeks.