An ulcer is an open, painful sore. Peptic ulcers affect the stomach and the upper part of the small intestine, called the duodenum (pronounced: doo-uh-DEE-num). Ulcers in the stomach are also called stomach ulcers or gastric ulcers. Those in the duodenum are also called duodenal ulcers.
Peptic ulcers are common, but mostly affect adults. Most can be cured.
What Causes an Ulcer?
Most peptic ulcers are caused by:
bacteria called Helicobacter pylori (or H. pylori) infecting the stomach and upper intestine. They weaken the protective coating of the stomach and upper small intestine. Acid in the stomach then gets through to the sensitive lining underneath. Acid and bacteria irritate this lining, causing ulcers.
using nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and aspirin. These medicines fight inflammation and help treat long-term, painful conditions like arthritis. If taken in high doses over a long period of time, NSAIDs can cause ulcers in some people.
smoking cigarettes. Smoking increases the risk of ulcers because nicotine causes the stomach to make more acid. Drinking a lot of alcohol each day for a period of time can also increase a person's risk of ulcers. Over time, alcohol can wear down the lining of the stomach and intestines.
Sometimes stress can help cause ulcers. Usually this happens only when a person has an illness involving severe emotional or physical stress. Any illness that makes it hard for the body to heal (such as serious burns from a fire) also can make someone more likely to get an ulcer.
What Are the Signs & Symptoms of Peptic Ulcers?
Stomach pain is the most common sign of an ulcer. It usually feels like sharp aches between the breastbone and the belly button. This pain often comes a few hours after eating. It can also happen during the night or early in the morning, when the stomach is empty. Eating something or taking acid suppressor (antacid) medicine sometimes eases the pain.
Other symptoms of ulcers can include:
loss of appetite
sudden, sharp stomach pains
burping or hiccupping a lot
vomiting (if there’s blood in the vomit or the vomit looks like coffee grounds, which only happens with severe ulcers, call a doctor right away)
bloody or blackish bowel movements (this could be a sign of a serious problem, so call a doctor right away if you see this)
Anyone who thinks they might have an ulcer needs to see a doctor. An ulcer that’s not treated can grow larger and deeper. This can lead to other problems, such as bleeding in the digestive system or a hole in the wall of the stomach or duodenum, which can make someone very sick.
How Are Ulcers Diagnosed?
To diagnose a peptic ulcer, doctors do an exam, ask about symptoms, and take a medical history. If you have stomach pain or other symptoms of an ulcer, the doctor will do some tests.
One test is called an upper gastrointestinal (GI) series. These are X-rays of the stomach, duodenum, and esophagus, the muscular tube that links the mouth to the stomach. A person drinks a liquid called barium while getting an X-ray. If there’s an ulcer, it should show up on the X-ray.
Another common test to look for an ulcer is an endoscopy (pronounced: en-DOSS-kuh-pee). A person is sedated for this procedure. Then, the doctor puts an endoscope — a small, flexible tube with a tiny camera on the end — down the throat and into the stomach and duodenum. The doctors can see the lining of the esophagus, stomach, and duodenum to check for possible ulcers.
A doctor also can do a blood test that looks for H. pylori bacteria. This may be important if the upper GI series showed an ulcer. The blood test can be done right in the doctor's office. Sometimes doctors test a poop sample (called a stool test) or a person's breath to check for the H. pylori bacteria.
How Are Ulcers Treated?
Most H. pylori-related ulcers can be cured. Treatment involves two kinds of antibiotics and an acid suppressor (antacid). The person takes the antibiotics for 2 weeks and the antacid for 2 months or longer. The ulcer may take 8 weeks to heal, but the pain usually goes away after a few days or a week.
Can Peptic Ulcers Be Prevented?
Doctors aren’t sure how H. pylori bacteria spread from person to person. The bacteria have been found in saliva (spit), so kissing may be one way. They also may spread through food, water, or contact with vomit (puke) that’s infected with the bacteria.
Regular use of NSAIDs can cause gastrointestinal problems and bleeding in some people. Acetaminophen does not cause stomach ulcers and is a good alternative to NSAIDs.
As with many infections, washing your hands well and often is an important part of ulcer prevention. This is extra important after you use the bathroom and before you eat. And take good care of your body by exercising regularly and not smoking or drinking.
Medically reviewed by: J. Fernando del Rosario, MD