Peptic ulcer

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at April 23, 2016
StartDiseasesPeptic ulcer

Peptic ulcers are sores that develop in the lining of the esophagus, the duodenum, or the stomach. Bacterial infections, over-the-counter medicines and prescription anti-inflammatory medications are typically some of the leading causes of peptic ulcers, which are also called stomach ulcers.


Definition & Facts

Peptic ulcers are are a common problem with the gastrointestinal tract which affect millions of Americans every year. When the gastrointestinal lining becomes irritated, ulcers can develop in the esophagus, the stomach, or the duodenum. The condition is typically named for the specific location of the irritation.

When the ulcers form in the stomach, the condition is referred to as a gastric ulcer. Esophageal ulcers emerge in the esophagus and duodenal ulcers form in the duodenum which is a part of the small intestine. Even with proper treatment the ulcers may recur unless patients take the necessary precautions.

Corrosive acid or peptic juices released by the stomach further damage the already inflamed and swollen lining. Without treatment, the sores open, enlarge and spread deeper within the lining's tissues. The swelling involved with the disorder may lead to a gastric outlet obstruction. Chronic ulcers can also lead to the development of stomach cancer.

Symptoms & Complaints

Symptoms accompanying peptic ulcer development largely depend on the location and the severity of the condition. Initially, patients may feel nothing. Many commonly experience indigestion or abdominal discomfort one to three hours after consuming a meal. Complaints of burning pain near the sternum to the navel region may occur. The discomfort may feel like burning, a dull ache, or sharp pains.

Some feel hungry one to three hours after eating. Others awaken during the night with hunger pangs or discomfort. The symptoms last anywhere from a few minutes to several agonizing hours.

Additional symptoms reported on a less frequent basis include burping, nausea, and vomiting, loss of appetite or unexplained weight loss. As the ulcers progress and bleeding occurs, patients may vomit what looks like coffee grounds or have blackened stools.


In recent decades, researchers have identified Helicobacter pylori bacterium colonies in the gastrointestinal tract as a major contributing factor to peptic ulcers. Statistics suggest that up to half of the elderly population over 60 harbors the bacteria, which causes an active infection and ulcers in up to 15 percent of the geriatric population. Since the discovery, ulcers related to this type of infection have been reduced from 50 to 20 percent.

Aspirin, ibuprofen, etodolac, and naproxen are some of the anti-inflammatory analgesic medications that also lead to peptic ulcer formation when used chronically. Chemical compounds known as prostaglandins usually protect the sensitive gastrointestinal lining from acid exposure. However, NSAIDS interfere with prostaglandin production and secretion, which then leaves the delicate tissue vulnerable.

Cigarette smoking is another contributing factor. Smoking encourages gastric acid production and secretion, which leads to irritation and ulcers. The habit also interferes with ulcer treatment and the healing process.

Diagnosis & Tests

Peptic ulcers are commonly diagnosed using upper gastrointestinal or upper GI studies. Patients are first required to drink a thick fluid containing barium. The substance coats the pathways and organs, which are then more clearly visible during an X-ray.

Physicians may also order an upper endoscopy or Esophagogastroduodenoscopy (EGD), which internally examines the lining of the esophagus, the stomach and the duodenum. The test involves passing the slender, lighted endoscope equipped with a camera into the mouth and down the throat. During the study, physicians may additionally take a small tissue sample or biopsy for microscopic evaluation.

Using particular staining methods on the sample, laboratory technicians are able to determine the presence of H. pylori or other microorganisms. A blood test or stool test can also be used to find bacteria. One of the more recent testing techniques includes a urea breath test. After swallowing a carbon-containing urea pill, patients exhale into the device. In the presence of H. pylori, the urea deteriorates and releases carbon dioxide. Higher than normal levels of the gas are then indicative of the bacteria.

Treatment & Therapy

Antacids continue being the first step in peptic ulcer treatment. Frequent doses reduce the amount of gastric acid, which then encourages the healing process without interference. Some of the more common antacids prescribed include aluminum or magnesium preparations known as Amphojel®, Maalox®, and Mylanta®.

Histamine antagonists or H2 blockers also prevent the stimulation of acid secretion. Commonly prescribed H2 blockers include cimetidine, famotidine, nizatidine, and ranitidine.

In recent years, physicians often prefer proton-pump inhibitor medications over antacids or histamine antagonists as they are more effective in suppressing acid production and release. The formulations also cause less undesirable side effects. Some of the more common medications in this classification include esomeprazole, lansoprazole, pantoprazole, and rabeprazole. Sucralfate and misoprostol act as a type of liquid adhesive bandage by coating ulcer surfaces. The formulations are also often prescribed for patients requiring chronic NSAID use to prevent peptic ulcer development.

Eliminating H. pylori colonies requires a combination of antibiotics that include amoxicillin, clarithromycin, levofloxain, and metronidazole. While various foods do not cause peptic ulcer formation, caffeine encourages gastric acid secretion, and alcohol often causes gastritis. When diagnosed with ulcers, physicians typically advise patients to limit or discontinue alcohol and caffeine consumption until complete healing occurs.

Prevention & Prophylaxis

Individuals may prevent ulcer formation by eliminating habits that increase the production and release of stomach acids. Quitting smoking and drinking alcohol and caffeinated beverages in moderation can act as preventative measures.

For people needing to take routine doses of aspirin for cardiovascular disease or NSAIDs for chronic pain, physicians may recommend that patients also take medications that help minimize the effects of the formulations on the gastrointestinal tract. If problems arise, physicians might prescribe alternative medications that have fewer gastric side effects.

Preventing H. pylori infections involves developing good habits of personal hygiene. Washing hands thoroughly after using the bathroom, before and after working with raw foods, can help prevent infection. Avoiding eating contaminated or spoiled foods or drinking contaminated water are also good preventative measures for avoiding infection.