Peptic Ulcer Disease

A peptic ulcer is a sore on the lining of the stomach or duodenum, the beginning of the small intestine. Less commonly, a peptic ulcer may develop just above the stomach in the esophagus, the tube that connects the mouth to the stomach.

A peptic ulcer in the stomach is called a gastric ulcer. One that occurs in the duodenum is called a duodenal ulcer. People can have both gastric and duodenal ulcers at the same time. They also can develop peptic ulcers more than once in their lifetime.

What causes peptic ulcers?

A bacterium called Helicobacter pylori (H. pylori) is a major cause of peptic ulcers. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen, are another common cause. Rarely, cancerous or noncancerous tumors in the stomach, duodenum, or pancreas cause ulcers.

Peptic ulcers are not caused by stress or eating spicy food, but both can make ulcer symptoms worse. Smoking and drinking alcohol also can worsen ulcers and prevent healing.

What is H. pylori?

H. pylori is a type of bacteria—a germ that may cause infection. H. pylori infection is common, particularly in developing countries, and often begins in childhood. Symptoms usually don't occur until adulthood, although most people never have any symptoms.

H. pylori causes more than half of peptic ulcers worldwide. The bacterium causes peptic ulcers by damaging the mucous coating that protects the stomach and duodenum. Damage to the mucous coating allows powerful stomach acid to get through to the sensitive lining beneath. Together, the stomach acid and H. pylori irritate the lining of the stomach or duodenum and cause an ulcer.

Yet, most people infected with H. pylori never develop ulcers. Why the bacterium causes ulcers in some people and not in others is not known. Most likely, development of ulcers depends on characteristics of the infected person; the type, or strain, of H. pylori present; and factors researchers have yet to discover.

How is H. pylori spread?

Researchers are not certain how H. pylori is transmitted, although they think it may be spread through contaminated food or water. People may pick up the bacterium from food that has not been washed well or cooked properly or from drinking water that has come from an unclean source.

Other research is exploring how infection spreads from an infected person to an uninfected person. Studies suggest that having contact with the stool or vomit of an infected person can spread H. pylori infection. And H. pylori has been found in the saliva of some infected people, which means infection could be spread through direct contact with saliva.

What are the symptoms of a peptic ulcer?

Abdominal discomfort is the most common symptom of both duodenal and gastric ulcers. Felt anywhere between the navel and the breastbone, this discomfort usually

  • is a dull or burning pain
  • occurs when the stomach is empty—between meals or during the night
  • may be briefly relieved by eating food, in the case of duodenal ulcers, or by taking antacids, in both types of peptic ulcers
  • lasts for minutes to hours
  • comes and goes for several days or weeks

Other symptoms include

  • weight loss
  • poor appetite
  • bloating
  • burping
  • nausea
  • vomiting

Some people experience only mild symptoms or none at all.

Emergency Symptoms

A person who has any of the following symptoms should call a doctor right away:

  • sharp, sudden, persistent, and severe stomach pain
  • bloody or black stools
  • bloody vomit or vomit that looks like coffee grounds

These “alarm” symptoms could be signs of a serious problem, such as

  • bleeding—when acid or the peptic ulcer breaks a blood vessel
  • perforation—when the peptic ulcer burrows completely through the stomach or duodenal wall
  • obstruction—when the peptic ulcer blocks the path of food trying to leave the stomach

Content provided by NDDIC