A peptic ulcer is a sore that forms when digestive juices wear away the lining of the digestive system. A peptic ulcer can occur in the lining of the stomach, duodenum, or lower part of the esophagus. Symptoms can include indigestion-like pain, nausea, and weight loss.
Globally, it is estimated that up to 10 percent of adults are affected by peptic ulcers at least once in their lifetime. In the United States, around 500,000 people develop a peptic ulcer each year.
When a peptic ulcer affects the stomach, it is called a gastric ulcer, one in the duodenum is called a duodenal ulcer, and an esophageal ulcer is an ulcer in the esophagus.
The most common causes are Helicobacter pylori (H. pylori) bacteria and the use of non-steroidal anti-inflammatory drugs.
Fast facts on peptic ulcers:
Peptic ulcers can affect anywhere in the digestive system.
Symptoms include stomach pain, sometimes feeling like indigestion, and nausea.
Causes include bacteria and certain types of medication.
Treatments include proton pump inhibitors (PPIs) and antibiotics.
Peptic ulcers affect the digestive system.
It is not uncommon for people to have a peptic ulcer and no symptoms at all. However, one of the most common symptoms of peptic ulcers is indigestion-like pain.
The pain may occur anywhere from the belly button to the breastbone. It can be brief or may last for hours. It is more severe when the stomach is empty or right after eating (depending on where it is located); sometimes it is worse during sleep. Eating certain foods may relieve it, and some foods may make it worse.
Other symptoms include:
difficulty swallowing food
food that is eaten comes back up
feeling unwell after eating
loss of appetite
Over-the-counter medications can often provide relief for these symptoms. Rarely, ulcers can cause severe signs and symptoms, such as:
black and tarry stools, or stools with dark red blood
nausea and vomiting that is especially persistent and severe
These symptoms indicate a medical emergency. The patient should see a doctor immediately.
The risk of complications increases if the ulcer is left untreated, or if treatment is not completed. Complications can include:
hemodynamic instability, a result of internal bleeding which can affect multiple organs and be a serious complication
peritonitis, in which the ulcer bores a hole through the wall of the stomach or small intestine
pyloric stenosis, a chronic inflammation in the lining of the stomach or duodenum
Peptic ulcers can recur. Having a first ulcer increases the risk of developing another one later.
The type of treatment usually depends on what caused the peptic ulcer. Treatment will focus on either lowering stomach acid levels so that the ulcer can heal, or eradicating the H. pylori infection.
Proton pump inhibitors (PPIs)
PPIs reduce the amount of acid the stomach produces. They are prescribed for patients who test negative for H. pylori infection. Treatment usually lasts 1-2 months, but if the ulcer is severe, treatment may last longer.
H. pylori infection treatment
Patients infected with H. pylori will usually need PPIs and antibiotics. This treatment is effective in most patients, and the ulcer will start to disappear within days. When treatment is over, the individual will have to be tested again to make sure the H. pylori have gone. If necessary, they will undergo another course of different antibiotics.
Non-steroidal anti-inflammatory drugs
If the ulcer comes from NSAIDs, the patient will have to stop taking them. Alternatives include acetaminophen. If the person cannot stop taking NSAIDs, the doctor may minimize the dosage and review the patient’s need for them later. Another medication may be prescribed long term, alongside the NSAID.
Even after the ulcer has healed and treatment has been completed, the patient may still have indigestion. In such cases, the doctor might advise some diet and lifestyle changes. If symptoms persist, low-dose PPI or H2-receptor antagonists might be prescribed. In severe cases with bleeding, an endoscopy may be needed to stop the bleeding at the ulcer site.
Dietary changes can be important for treating and preventing peptic ulcers.