Peptic ulcers are open sores that develop on the inside lining of the stomach, lower esophagus and the upper portion of the small intestine. They are usually formed as a result of inflammation caused by the bacteria Helicobacter pylori, as well as from erosion from stomach acids. The most common symptom of a peptic ulcer is stomach pain.

Peptic ulcers include:

• Gastric ulcers that occur on the inside of the stomach
• Esophageal ulcers that occur inside the esophagus
• Duodenal ulcers that occur on the inside of the upper portion of your small intestine (duodenum)

Causes

The most common causes of peptic ulcers are infection with the bacterium Helicobacter pylori and continuing use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen. Stress, anxiety and spicy foods do not cause peptic ulcers. However, they can make your symptoms worse.

Symptoms

• Burning abdominal pain (that radiates from the navel to the chest)
• Feeling of fullness, bloating or belching
• Bloody or dark stools
• Intolerance to fatty foods
• Heartburn
• Nausea

The most common peptic ulcer symptom is burning abdominal pain. Stomach acid makes the pain worse, as does having an empty stomach. The pain can often be relieved by eating certain foods that buffer stomach acid or by taking an acid-reducing medication, but then it may come back. The pain may be worse between meals and at night.

Many people with peptic ulcers don’t even have symptoms.

Causes

Peptic ulcers occur when acid in the digestive tract eats away at the inner surface of the stomach or small intestine. The acid can create a painful open sore that may bleed.

Your digestive tract is coated with a mucous layer that normally protects against acid. But if the amount of acid is increased or the amount of mucus is decreased, you could develop an ulcer.

Common causes include:

• A bacterium. Helicobacter pylori bacteria commonly live in the mucous layer that covers and protects tissues that line the stomach and small intestine. Often, the H. pylori bacterium causes no problems, but it can cause inflammation of the stomach’s inner layer, producing an ulcer. It’s not clear how H. pylori infection spreads. People may contract H. pylori through food and water.

• Regular use of certain pain relievers. Taking aspirin, as well as certain over-the-counter and prescription pain medications called nonsteroidal anti-inflammatory drugs (NSAIDs), can irritate the lining of your stomach and small intestine. These medications include ibuprofen, anaproxen sodium, ketoprofen and others. They do not include acetaminophens.

• Other medications. Taking certain other medications along with NSAIDs, such as steroids, anticoagulants, low-dose aspirin, selective serotonin reuptake inhibitors (SSRIs), alendronate (Fosamax) and risedronate (Actonel), can greatly increase the chance of developing ulcers.

Risk factors

In addition to having risks related to taking NSAIDs, you may have an increased risk of peptic ulcers if you:

• Smoke. Smoking may increase the risk of peptic ulcers in people who are infected with H. pylori.
• Alcohol. Alcohol can irritate and erode the mucous lining of your stomach, and it increases the amount of stomach acid that’s produced.
• Have untreated stress.
• Eating spicy foods.

Alone, these factors do not cause ulcers, but they can make ulcers worse and more difficult to heal.

Complications

Left untreated, peptic ulcers can result in:

• Internal bleeding. Bleeding can occur as slow blood loss that leads to anemia or as severe blood loss that may require hospitalization or a blood transfusion. Severe blood loss may cause black or bloody vomit or black or bloody stools.
• A hole (perforation) in your stomach wall. Peptic ulcers can eat a hole through (perforate) the wall of your stomach or small intestine, putting you at risk of serious infection of your abdominal cavity (peritonitis).
• Obstruction. Peptic ulcers can block passage of food through the digestive tract, causing you to become full easily, to vomit and to lose weight either through swelling from inflammation or through scarring.
• Gastric cancer. Studies have shown that people infected with H. pylori have an increased risk of gastric cancer.

Prevention

You may reduce your risk of peptic ulcer if you follow the same strategies recommended as home remedies to treat ulcers. It also may be helpful to:

• Protect yourself from infections. It’s not clear just how H. pylori spreads, but there’s some evidence that it could be transmitted from person to person or through food and water.
• You can take steps to protect yourself from infections, such as H. pylori, by frequently washing your hands with soap and water and by eating foods that have been cooked completely.
• Use caution with pain relievers. If you regularly use pain relievers that increase your risk of peptic ulcer, take steps to reduce your risk of stomach problems. For instance, take your medication with meals.
• Work with your doctor to find the lowest dose possible that still gives you pain relief. Avoid drinking alcohol when taking your medication, since the two can combine to increase your risk of stomach upset.
• If you need an NSAID, you may need to also take additional medications such as an antacid, a proton pump inhibitor, an acid blocker or cytoprotective agent. A class of NSAIDs called COX-2 inhibitors may be less likely to cause peptic ulcers, but may increase the risk of heart attack.

When to see a doctor

See your doctor if you have any of the symptoms as listed above. Also see your doctor if over-the-counter antacids and acid blockers relieve your pain but the pain returns.

We will discuss the diagnosis and treatment of peptic ulcers in detail in our next article.