American Gastroenterological Association: Peptic Ulcer Disease

Peptic Ulcer Disease

Your stomach lining is a remarkably resilient membrane pitted with openings much like that of a sponge. It allows gastric juices as toxic as car battery acid to begin the digestion process.

Peptic ulcer disease occurs when stomach acid penetrates the stomach and/or duodenal lining and causes sores or erosions that may bleed, lead to anemia and/or cause abdominal pain.

An estimated four million Americans have peptic ulcer disease.

Peptic Ulcer Disease

When a type of bacteria called Helicobacter pylori (H. pylori) infects your stomach lining by living in or on it, it can cause an ulcer, or sore, in the stomach or duodenum, the first part of the small intestine. This ulcer can cause pain or bleeding.

Untreated, the ulcer can literally eat a hole in the stomach lining, requiring surgery. Chronic inflammation from an ulcer can cause swelling and scarring. Over time, this scarring may close (obstruct) the outlet of the stomach, preventing the passage of food and causing vomiting and weight loss. In severe cases, ulcer complications can lead to death.

What Causes Ulcers?

Scientists have recently discovered that most duodenal ulcers are caused by infection, not spicy food or stress. Scientists do not know how the H. pylori bacteria are transmitted, but they know that the bacteria may be spread from person to person.

The second most common cause of ulcers is the use of pain medications called non-steroidal anti-inflammatory drugs (NSAIDs), which include aspirin and ibuprofen. People often take NSAIDs to reduce pain and inflammation, often for arthritis. Frequent or longtime use of NSAIDs, especially among older persons, however, can increase a person’s risk of ulcer.

What are the Symptoms of Peptic Ulcer Disease?

The most common symptom of an ulcer is a burning pain in the stomach, between your breastbone and your belly button. You’ll often feel this pain when your stomach is empty-between meals generally-but it can occur at any time. Sometimes this pain will wake you in the middle of the night. The pain will last anywhere from a few minutes to several hours.

While not as common as stomach pain, other symptoms include nausea, vomiting, blood in the stool, or loss of appetite. Bleeding may be the first and only symptom of an ulcer. When an ulcer bleeds and continues to bleed without treatment, a person may become anemic and weak.

NSAID-induced ulcers are also common and may cause pain, anemia, or bleeding.

What Should I Do if I Have Symptoms of Peptic Ulcer Disease?

Call your doctor and schedule an appointment as soon as possible. Your doctor may give you one of several tests to determine if you are infected with

H. pylori, one being a simple blood test. In this case, your doctor will send your blood sample to a lab to be tested for evidence of antibodies to the bacteria. Another test for H. pylori is a breath test that requires you to drink a liquid, after which, about one hour later, you breathe into a container.

Yet another test for ulcers or other causes of your symptoms involves the use of endoscopy. In this test, the doctor inserts a small flexible tube through the mouth and into the stomach. The tube has a camera inside that allows the doctor to look for the presence of the inflammation or ulcers. The doctor can also take small samples from your stomach lining to be tested for the presence of H. pylori. Usually, you will be sedated during this procedure.

An alternative to endoscopy is an X-ray test, where you are given a chalk-like tasting liquid to drink, after which X-rays are taken to show the outline of your digestive track. This test is called an Upper GI Series.

How Do I Know if I’m at Risk for an NSAID-Induced Ulcer?

You’re at risk for NSAID-induced ulcers if you:

* Are age 60 or older (although ulcers from NSAIDs can occur at any age)

* Experience certain side effects after taking NSAIDs, such as upset stomach and heartburn

* Have had past experiences with ulcers and internal bleeding

Your doctor may also ask you how long you’ve been taking NSAIDs, your use of acid-blocking drugs or antacids, any use of tobacco or alcohol, and prior or current diseases, such as heart disease.

What is the Treatment for Peptic Ulcer Disease?

If you have been diagnosed with H. pylori infection, your doctor will prescribe a treatment plan to kill the infection and reduce the acid in your stomach. It is important to follow the treatment plan exactly as your doctor has prescribed, and if you smoke, you should stop, as smoking inhibits ulcer healing. You should also not take NSAIDs, like aspirin or ibuprofen, and avoid alcoholic beverages.

Will I Need Surgery?

You will only need surgery if an ulcer fails to heal, you have complications, or a perforation or obstruction in the stomach develops. If you have surgery, the surgeon may remove the ulcer altogether, or “oversew” it with tissue taken from another part of the intestine. Other options include tying off the bleeding artery or cutting off the nerve supply to the base of the stomach.

What Can We Expect in the Future?

Eventually, we will understand how H. pylori is spread and how to prevent this infection. Meanwhile, the good news is that treatment programs are available to eliminate the infection and prevent duodenal ulcer recurrence.


Since the source of H. pylori infection is not yet known, no definitive recommendations have been made. However, it is always wise to wash your hands thoroughly, eat food that has been properly prepared, and drink water from a clean, safe source. If you have had ulcers in the past, you should be tested for H. pylori infection.

You can reduce your risk of NSAID-induced ulcers by:

* Trying a different NSAID

* Reducing the dose and frequency

* Following your doctor’s treatment plan to protect your stomach duodenum

* Substituting another pain-relief medication such as acetaminophen, after consulting with your doctor

If you are taking NSAIDs regularly, discuss with your doctor ways to protect your stomach while getting pain relief.


Antibodies – Part of the immune system that fights disease.

Bacteria – Germs that cause human disease.

Duodenum – First part of the small intestine.

Endoscopy – A procedure in which the doctor inserts a small flexible tube-an endoscope-through the mouth, down the esophagus, and into the stomach and duodenum. The doctor can look through the endoscope to determine the presence of disease.

Esophagus – A tube-like organ leading from the mouth to the stomach.

Gastritis – Inflammation of the stomach lining.

Helicobacter pylori (H. pylori) – The name of the bacterium that causes disease (gastritis and ulcers)in humans.

Inflammation – A response to tissue injury that can cause redness, swelling, and pain.

Peptic – A description relating to digestion.

Stomach – A pouch-like organ that connects the esophagus to the small intestine. It receives swallowed food and secretes juices high in acid to break down food.

Ulcer – A sore or wound in the lining of the stomach or duodenum.

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This brochure is part of the Patient Wellness Series produced by the American Gastroenterological Association (AGA) and funded by an educational grant from Glaxo Wellcome Institute for Digestive Health. For more information regarding your digestive health, visit the AGA Digestive Health Resource Center at

COPYRIGHT 1999 American Gastroenterological Association

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