Peptic Ulcer

A peptic ulcer is an open sore in the lining of the stomach. It may also occur in the  first part of the small intestine (duodenum). 

Causes

The most common causes of ulcers are:

  • H. pylori bacteria infection

  • Long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen

Other factors that can increase the risk for ulcers include older age and family history of peptic ulcers, and use of certain medicines. Tobacco and alcohol use are also risk factors. Emotional stress, worry, and spicy foods don't cause peptic ulcers.

Symptoms

A peptic ulcer may or may not cause symptoms. If symptoms do occur, they can include:

  • Dull or burning pain anywhere between your belly button and breastbone

  • Loss of appetite

  • Heartburn or upset stomach

  • Frequent burping

  • Bloated feeling

  • Nausea or vomiting. Vomit may be bloody or look like coffee grounds.

  • Black, tarry, or bloody stools (which means the ulcer is bleeding)

Sometimes the bleeding is not seen. In these cases, it may be discovered by symptoms of low blood count (anemia) such as dizziness, weakness, shortness of breath, pale skin, trouble with exercise, or a blood test.

If an ulcer is suspected, your healthcare provider may check for H. pylori infection. To do this, you may have blood, stool, or breath tests. Upper endoscopy (EGD) is usually done to check for ulcers and take samples (biopsies) to be evaluated under the microscope. An X-ray test called an upper GI series can be done in some cases, but it could miss small ulcers that would be seen on the upper endoscopy.

Without treatment, a peptic ulcer may worsen. This can lead to serious problems such as bleeding, blockage, or a hole (perforation) in the stomach or duodenum. Treatment is needed to prevent these problems.

Medicines are the most common treatment for peptic ulcers. In severe cases, surgery may be needed.

Home care

Medicines

If you’re prescribed medicines, be sure to take them as directed. Common medicines prescribed include:

  • Antibiotics. These kill H. pylori bacteria. In many cases, you’ll need to take at least 2 types of antibiotics. The regimens can be complicated and require many medicines either at once, or taken in order. This is because this bacteria is often hard to treat. It's very important to take the medicines as prescribed. 

  • Proton pump inhibitors. These block your stomach from making any acid.

  • H2 blockers. These reduce the amount of acid your stomach makes. These are sometimes used for duodenal ulcers.

  • Bismuth subsalicylate. This helps protect the lining of your stomach and duodenum from acid.

General care

  • Don’t take any NSAIDS such as aspirin, ibuprofen, or naproxen without talking with your healthcare provider first. They may delay healing. Also check with your healthcare provider before taking any antacids.

  • Don't use alcohol or tobacco. These may delay healing. They may also make symptoms worse.

Follow-up care

Follow up with your healthcare provider as directed. If testing was done, you’ll be told the results when they are ready. In some cases of gastric ulcer, a repeat upper endoscopy is needed to check for healing. Your healthcare provider may also do a test of cure after treatment for H. pylori.

When to seek medical advice

Call your healthcare provider right away if any of these occur:

  • Fever of 100.4°F (38°C) or higher, or as directed by your healthcare provider

  • Stomach pain that worsens or moves to the lower right part of abdomen

  • Continued weight loss

  • Pale skin

  • Fast heartbeat

  • Weakness or dizziness

  • Extreme fatigue

  • Shortness of breath

  • Frequent vomiting, blood in your vomit, or coffee ground-like substance in your vomit

  • Black, tarry, or bloody stools

Call 911

Call 911 right away if any of these occur:

  • Sudden or severe pain in the stomach region

  • Stomach becomes rigid

  • Low body temperature

  • Unusually fast heart rate

  • Chest pain appears or worsens, or spreads to the back, neck, shoulder, or arm

  • Trouble breathing or swallowing

  • Confusion

  • Extreme drowsiness or trouble waking up

  • Fainting

  • Large amounts of blood in the vomit or stool

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