Peptic Ulcer Disease

Peptic ulcer disease (PUD) is a condition that causes ulcers (open sores) to develop in the lining of your digestive tract. The word “peptic” comes from pepsin, a digestive enzyme that your stomach produces. Pepsin and stomach acid help break down food for digestion. These substances are highly corrosive.

Normally, a strong mucous lining protects your digestive tract from these substances. But in peptic ulcer disease, this protection breaks down. Pepsin and acids eat into the lining, forming ulcers. Most ulcers form in your stomach or duodenum, where these substances are most active. But they can also occur elsewhere.

Types of peptic ulcers

Peptic ulcers usually develop in your stomach or duodenum.

• Duodenal ulcers account for almost 80% of peptic ulcers.
• Stomach ulcers account for almost 20% of peptic ulcers.

Rarely, they can appear in other parts of your digestive tract:

• Esophageal ulcers: Chronic acid reflux can erode the lining of your esophagus, which doesn’t have the same protection as your stomach.
• Jejunal ulcers: These can occur after surgery that connects your stomach to your jejunum (gastrojejunostomy).

What are peptic ulcer disease symptoms?

Up to 70% of people with peptic ulcer disease don’t notice symptoms. But the most common ones are central upper abdominal pain (epigastric pain) and indigestion. Indigestion often happens after eating and feels like a burning or gnawing sensation.

Other possible symptoms related to peptic ulcer disease include:

• Bloating
• Burping
• Heartburn
• Loss of appetite
• Nausea and vomiting
• Pain that wakes you up at night

What causes peptic ulcer disease?

The mucous lining in your digestive tract protects it from acids and enzymes and helps repair damage, especially in your stomach and duodenum. PUD happens when something weakens these defenses.

It takes a long-term issue to lower these defenses enough acid to erode the lining. Most cases are due to:

• H. pylori infection: This common bacteria lives in your stomach and/or duodenum. Most people have no symptoms, but if it grows too much, it can damage the lining.
• NSAID overuse: These common pain relievers (like aspirin and ibuprofen) are easy to get. But using them too often can upset the chemical balance in your stomach and duodenum.

Less common causes of peptic ulcer disease include:

• Other infections
• Chemotherapy
• Crohn’s disease
• Ischemia
• Radiation therapy
• Severe illness or injury
• Stomach cancer
• Zollinger-Ellison syndrome

You can also get a peptic ulcer in your:

• Jejunum: After gastric bypass surgery, the middle part of your small intestine becomes your new duodenum. But it doesn’t have the same protective lining.
• Esophagus: From chronic inflammation (esophagitis), often a result of acid reflux (GERD). Other causes include infections, medications or autoimmune diseases.

Risk factors

You have a higher risk if you have an H. pylori infection, take NSAIDs often, or both. Other things, like smoking, alcohol and certain medications, can contribute to your risk.

Complications of peptic ulcer disease

Without treatment, PUD can lead to:

• Gastrointestinal bleeding: Ongoing blood loss from an ulcer
• Gastrointestinal perforation: An ulcer that makes a hole in your GI tract — this is an emergency

Symptoms of these complications may include:

• Blood in your stool
• Blood in your vomit
• Sudden, sharp stomach pain
• Abdominal swelling and tenderness

How doctors diagnose peptic ulcer disease

If your symptoms suggest an ulcer, your provider will examine you and test for H. pylori infection. This might include a breath or stool test.

Imaging tests like a CT scan or GI X-ray can spot large ulcers. Many people get a final diagnosis from an upper endoscopy. This also allows your provider to test for H. pylori directly.

What are peptic ulcer disease treatments?

Most peptic ulcers heal with medication. But if you have complications (like a bleeding or perforated ulcer), you may need more care. Many issues can be treated during an endoscopy.

Medications

Medications can reduce acid, protect your lining and treat infection. They include:

• Antibiotics for H. pylori
• Cytoprotective agents to coat and protect your lining
• H2 blockers to lower stomach acid
• Proton pump inhibitors (PPIs) to lower acid and protect your lining

Procedures

If you have a bleeding ulcer, your provider may treat it during endoscopy by cauterizing the wound or injecting medication. A perforation may need stitches.

Rarely, people need surgery for ulcers that don’t heal or that keep coming back. This can involve:

• Removing scar tissue or opening a blocked stomach outlet (pyloroplasty)
• Cutting the nerve that triggers acid release (vagotomy)

When should I see my healthcare provider?

See a provider if you think you might have a peptic ulcer. Over-the-counter medications may ease pain, but they won’t fix the root cause.

Even if your symptoms are mild, untreated ulcers can get worse. H. pylori can also lead to other problems, like stomach cancer.

Get emergency care if you have:

• Severe stomach pain that doesn’t go away
• Blood in your poop or vomit
• Signs of severe blood loss, like pale skin or fainting

Do peptic ulcers go away on their own?

They might, but only if the cause goes away. If you have H. pylori or another condition, you’ll need treatment. Even if NSAIDs were the cause and you’ve stopped taking them, you should still get checked to rule out infection.

What is the prognosis after treatment for peptic ulcer disease?

Most peptic ulcers heal within a few weeks. Most people take medications for about two months. Treatment is usually effective, but people with chronic conditions may need long-term therapy.

Your healthcare provider may test again after treatment to make sure the ulcer has healed and the infection is gone. H. pylori can come back, and ulcers may return if the cause isn’t addressed.

Can peptic ulcer disease be prevented?

Yes. The two most important things you can do are:

• Find and treat H. pylori. Most people don’t know they have it. A simple breath test can detect it. If you’ve had it before, consider retesting. It can come back.
• Use NSAIDs carefully. Don’t take more than recommended. If you’ve had ulcers before, you may need to avoid them or take them with another medicine to protect your stomach.

Should I adjust my diet while living with peptic ulcer disease?

Foods don’t cause peptic ulcers, but some can make symptoms worse, especially spicy or acidic foods. Alcohol and smoking can also aggravate ulcers. Avoid these if you have symptoms or a history of peptic ulcer disease.