Peptic (stomach) ulcers

The stomach produces a strong acid to help digest food and protect against bacteria and other microorganisms. To protect the tissues from this acid, the stomach also secretes a thick layer of mucus.

If the mucus layer wears away and stops functioning effectively, the acid can damage tissue in the stomach lining, esophagus or the top part of the small intestine, causing ulcers.

When the ulcer is in the stomach, it's called a gastric or peptic ulcer. When the ulcer is in the duodenum (small intestine), it’s called a duodenal ulcer.

About 10% of people in Western countries will develop an ulcer in the stomach or small intestine at some point in their lives. Stomach ulcers are relatively easy to cure, but they can cause significant problems if left untreated.

Symptoms of peptic (stomach) ulcers

A peptic (stomach) ulcer doesn’t always cause symptoms. If it does, common symptoms may include any of the following:

• Pain or discomfort in the upper part of your abdomen, anywhere between your belly button and breastbone
• Feeling full very quickly while eating a meal
• Feeling uncomfortably full after eating a meal
• Nausea and vomiting
• Bloating
• Belching
• Heartburn or indigestion

In the most severe cases, a hole can form in the stomach, or a blockage could develop in the stomach or small intestine.

Pain can occur anywhere from the belly button to the breastbone and may feel worse at night and when you’re hungry. More severe symptoms include unexplained weight loss, nausea, vomiting blood or dark material, dark blood in the stool or black, tarry stool.

Some of the symptoms of stomach ulcers are similar to symptoms of gastroesophageal reflux disease and the conditions can occur at the same time. However, stomach ulcers don't cause reflux and reflux doesn't cause stomach ulcers.

Risk factors for peptic (stomach) ulcer disease

The following factors can increase your risk for developing peptic ulcer disease:

• Drinking excessive amounts of alcohol
• Regular use or overuse of aspirin, ibuprofen, naproxen or other nonsteroidal anti-inflammatory drugs (NSAIDs)
• Smoking cigarettes or chewing tobacco
• Radiation treatments

Causes of peptic (stomach) ulcer disease

Doctors and researchers no longer believe peptic (stomach) ulcers are caused by stress or spicy foods, although these factors can irritate existing ulcers.

The most common causes of peptic (stomach) ulcers are NSAIDs and Helicobacter pylori (H. pylori) bacteria. Less common causes include certain prescription medications including corticosteroids, medicines used to treat low bone mass and some antidepressants as well as infections caused by certain viruses, fungi or bacteria other than H. pylori. Surgery or medical procedures such as radiation that affect the stomach or small intestine are other less common causes of peptic ulcer disease.

How NSAIDs can cause ulcers

Taking nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen and naproxen can cause peptic (stomach) ulcers. NSAIDs relieve pain, but they also make the stomach lining more prone to damage and ulcers. You have a higher chance of developing a peptic (stomach) ulcer from NSAIDs if you take them for a long time, take high doses or more than one kind, and if you are also infected with H. pylori.

How H. pylori can cause ulcers

H. pylori bacteria is another common cause of peptic (stomach) ulcers. It can spread through contact with an infected person’s stool, vomit or saliva. About two-thirds of the world’s population is infected with H. pylori, but only 20% of those who are infected have symptoms.

When H. pylori enters your body, it attacks the mucous lining of your stomach, which protects your stomach from acids used to digest food. After a period of time, the bacteria eat through the stomach tissue and into the lining, causing ulcers. The ulcers may cause infections, bleeding or make it difficult for food to move through your digestive tract. If H. pylori isn’t treated, it can also lead to stomach cancer. Having good health habits can help keep you safe from getting H. pylori. These habits include:

• Making sure all food you eat has been cleaned and cooked safely
• Making sure that your drinking water is safe and clean
• Washing your hands with soap and water especially after using the bathroom and before eating

Getting a peptic (stomach) ulcer diagnosis

Your doctor may ask about your medical and family history, perform a physical exam, and order tests to diagnose a peptic (stomach) ulcer, find its cause and check for complications. Your doctor may order tests such as:

• Blood test or breath test: These tests check for H. pylori or other bacteria in your digestive system.
• Endoscopy: A flexible tube equipped with a light and tiny camera is inserted down the throat to see inside the esophagus and stomach.
• Stool culture: This test looks for any abnormal bacteria in your digestive tract that may cause diarrhea and other problems. A small stool sample is collected and sent to a lab. The test results will show if you have any abnormal bacteria.
• Upper gastrointestinal series: Sometimes called a barium swallow, this series of X-rays creates images of your esophagus, stomach and small intestine. You swallow a white liquid (containing barium) that coats your digestive tract and makes an ulcer more visible.

Foods you can eat with a stomach ulcer

There are no limits on foods you can eat when you have a stomach ulcer. You may find that some foods or drinks make your symptoms worse and decide to avoid them while you're receiving stomach ulcer treatments. Some of the most common irritants and foods to avoid with a stomach ulcer are excessive spices, chocolate, alcohol and substances that contain caffeine.

Ask your physician about foods or supplements that may help balance the bacteria in your digestive system such as probiotics, fermented foods, broccoli, berries and honey.

Lifestyle changes to reduce symptoms of stomach ulcers

If you’re living with peptic (stomach) ulcers, here are some things you can do to help reduce the pain, irritation and other symptoms:

• Stop using tobacco.
• Reduce alcohol consumption.
• Limit use of NSAIDs.

Peptic (stomach) ulcer treatments

If you have a peptic ulcer, your health care team will work with you to determine the best course of treatment. Stomach ulcer treatments may include:

• Antibiotics to kill the H. pylori bacteria
• Medications called cytoprotective agents that protect the tissue in the stomach lining
• Antacids
• H-2 receptor blockers to reduce acid levels in the stomach
• Proton pump inhibitors

If a peptic ulcer bleeds, medicine or heat therapy may need to be applied directly to the ulcer. Surgery may be needed if the bleeding won’t stop or if the ulcer has caused a tear in the stomach or small intestine.

Surgical treatment for peptic (stomach) ulcers

• Gastrectomy: This procedure removes the diseased part of the stomach.
• Vagotomy: The surgeon cuts the vagus nerve to reduce acid secretion.
• Antrectomy: This procedure removes the lower part of the stomach that produces a hormone that stimulates the stomach to secrete digestive juices. Sometimes, an adjacent part of the stomach that secretes pepsin and acid may be removed. A vagotomy is usually done along with an antrectomy.
• Pyloroplasty: The openings into the duodenum and small intestine are enlarged, enabling contents to pass from the stomach. This procedure may be performed along with a vagotomy.