Peptic Ulcers (Stomach Ulcers)

Return to Overview Page

Definition & Facts

What is a peptic ulcer?

A peptic ulcer is a sore on the lining of your stomach or duodenum. Rarely, a peptic ulcer may develop just above your stomach in your esophagus. Doctors call this type of peptic ulcer an esophageal ulcer.

Causes of peptic ulcers include

Two pictures of nonsteroidal anti-inflammatory drugs.
Nonsteroidal anti-inflammatory drugs can cause peptic ulcers.

Who is more likely to develop peptic ulcers caused by NSAIDs?

People of any age who take NSAIDs every day or multiple times per week are more likely to develop a peptic ulcer than people who do not take them regularly. NSAIDs are a class of pain killers, such as aspirin and ibuprofen. Long-term use of NSAIDs can cause peptic ulcer disease.

Your chance of having a peptic ulcer caused by NSAIDs, also called an NSAID-induced peptic ulcer, is increased if you

  • are age 70 or older
  • are female
  • are taking more than two types of NSAIDs or have taken NSAIDs regularly for a long time
  • have had a peptic ulcer before
  • have two or more medical conditions or diseases
  • are taking other medicines, such as corticosteroids and medicines to increase your bone mass
  • drink alcohol or smoke

Who is more likely to develop peptic ulcers caused by H. pylori?

About 30 to 40 percent of people in the United States get an H. pylori infection.1 In most cases, the infection remains dormant, or quiet without signs or symptoms, for years. Most people get an H. pylori infection as a child.2

Adults who have an H. pylori infection may get a peptic ulcer, also called an H. pylori-induced peptic ulcer. However, most people with an H. pylori infection never develop a peptic ulcer. Peptic ulcers caused by H. pylori are uncommon in children.2

H. pylori are spiral-shaped bacteria that can damage the lining of your stomach and duodenum and cause peptic ulcer disease. Researchers are not certain how H. pylori spread. They think the bacteria may spread through

  • unclean food
  • unclean water
  • unclean eating utensils
  • contact with an infected person’s saliva and other bodily fluids, including kissing

Researchers have found H. pylori in the saliva of some infected people, which means an H. pylori infection could spread through direct contact with saliva or other bodily fluids.3

Who develops peptic ulcers caused by tumors?

People who have Zollinger-Ellison syndrome (ZES) develop peptic ulcers caused by tumors. Anyone can have ZES, yet it is rare and only occurs in about one in every 1 million people.4 However, ZES is more common among men 30 to 50 years old. A child who has a parent with multiple endocrine neoplasia type 1 is also more likely to have Zollinger-Ellison syndrome.5

What other problems can a peptic ulcer cause?

A peptic ulcer can cause other problems, including

You may need surgery to treat these problems.

References

Symptoms & Causes

What are the symptoms of a peptic ulcer?

A dull or burning pain in your stomach is the most common symptom of a peptic ulcer. You may feel the pain anywhere between your belly button and breastbone. The pain most often

  • happens when your stomach is empty—such as between meals or during the night
  • stops briefly if you eat or if you take antacids
  • lasts for minutes to hours
  • comes and goes for several days, weeks, or months

Less common symptoms may include

  • bloating
  • burping
  • feeling sick to your stomach
  • poor appetite
  • vomiting
  • weight loss

Even if your symptoms are mild, you may have a peptic ulcer. You should see your doctor to talk about your symptoms. Without treatment, your peptic ulcer can get worse.

Woman clutching her stomach which is in pain.
A dull or burning pain in your stomach is the most common symptom of peptic ulcers.

What causes a peptic ulcer?

Causes of peptic ulcers include

Sometimes peptic ulcers are caused by both NSAIDs and H. pylori.

How do NSAIDs cause a peptic ulcer?

To understand how NSAIDs cause peptic ulcer disease, it is important to understand how NSAIDs work. Nonsteroidal anti-inflammatory drugs reduce pain, fever, and inflammation, or swelling.

Everyone has two enzymes that produce chemicals in your body’s cells that promote pain, inflammation, and fever. NSAIDs work by blocking or reducing the amount of these enzymes that your body makes. However, one of the enzymes also produces another type of chemical that protects the stomach lining from stomach acid and helps control bleeding. When NSAIDs block or reduce the amount of this enzyme in your body, they also increase your chance of developing a peptic ulcer.

How do H. pylori cause a peptic ulcer and peptic ulcer disease?

H. pylori are spiral-shaped bacteria that can cause peptic ulcer disease by damaging the mucous coating that protects the lining of the stomach and duodenum. Once H. pylori have damaged the mucous coating, powerful stomach acid can get through to the sensitive lining. Together, the stomach acid and H. pylori irritate the lining of the stomach or duodenum and cause a peptic ulcer.

How do tumors from ZES cause peptic ulcers?

Zollinger-Ellison syndrome is a rare disorder that happens when one or more tumors form in your pancreas and duodenum. The tumors release large amounts of gastrin, a hormone that causes your stomach to produce large amounts of acid. The extra acid causes peptic ulcers to form in your duodenum and in the upper intestine.

When should you call or see a doctor?

You should call or see your doctor right away if you

  • feel weak or faint
  • have difficulty breathing
  • have red blood in your vomit or vomit that looks like coffee grounds
  • have red blood in your stool or black stools
  • have sudden, sharp stomach pain that doesn’t go away

These symptoms could be signs that a peptic ulcer has caused a more serious problem.

Guy calling his doctor while holding his stomach.
Call your doctor if the pain gets worse.

Diagnosis

How do doctors diagnose a peptic ulcer?

Your doctor will use information from your medical history, a physical exam, and tests to diagnose an ulcer and its cause. The presence of an ulcer can only be determined by looking directly at the stomach with endoscopy or an X-ray test.

Medical history

To help diagnose a peptic ulcer, your doctor will ask you questions about your medical history, your symptoms, and the medicines you take.

Be sure to mention medicines that you take without a prescription, especially nonsteroidal anti-inflammatory drugs (NSAIDs), such as

Doctor talking to a patient.

Physical Exam

A physical exam may help a doctor diagnose a peptic ulcer. During a physical exam, a doctor most often

  • checks for bloating in your abdomen
  • listens to sounds within your abdomen using a stethoscope
  • taps on your abdomen checking for tenderness or pain

Lab tests

To see if you have a Helicobacter pylori (H. pylori) infection, your doctor will order these tests:

Blood test. A blood test involves drawing a sample of your blood at your doctor’s office or a commercial facility. A health care professional tests the blood sample to see if the results fall within the normal range for different disorders or infections.

Urea breath test. For a urea breath test, you will drink a special liquid that contains urea, a waste product that your body makes as it breaks down protein. If H. pylori are present, the bacteria will change this waste product into carbon dioxide—a harmless gas. Carbon dioxide normally appears in your breath when you exhale.

A health care professional will take a sample of your breath by having you breathe into a bag at your doctor’s office or at a lab. He or she then sends your breath sample to a lab for testing. If your breath sample has higher levels of carbon dioxide than normal, you have H. pylori in your stomach or small intestine.

Stool test. Doctors use a stool test to study a sample of your stool. A doctor will give you a container for catching and storing your stool at home. You return the sample to the doctor or a commercial facility, who then sends it to a lab for analysis. Stool tests can show the presence of H. pylori.

Upper gastrointestinal (GI) endoscopy and biopsy

In an upper GI endoscopy, a gastroenterologist, surgeon, or other trained health care professional uses an endoscope to see inside your upper GI tract. This procedure takes place at a hospital or an outpatient center.

An intravenous (IV) needle will be placed in your arm to provide a sedative. Sedatives help you stay relaxed and comfortable during the procedure. In some cases, the procedure can be performed without sedation. You will be given a liquid anesthetic to gargle or spray anesthetic on the back of your throat. The doctor will carefully feed the endoscope down your esophagus and into your stomach and duodenum. A small camera mounted on the endoscope sends a video image to a monitor, allowing close examination of the lining of your upper GI tract. The endoscope pumps air into your stomach and duodenum, making them easier to see.

The doctor may perform a biopsy with the endoscope by taking a small piece of tissue from the lining of your esophagus. You won’t feel the biopsy. A pathologist examines the tissue in a lab.

Read more about Upper GI Endoscopy.

Upper GI series

An upper GI series looks at the shape of your upper GI tract. An x-ray technician performs this test at a hospital or an outpatient center. A radiologist reads and reports on the x-ray images. You don’t need anesthesia. A health care professional will tell you how to prepare for the procedure, including when to stop eating and drinking.

During the procedure, you’ll stand or sit in front of an x-ray machine and drink barium, a chalky liquid. Barium coats your esophagus, stomach, and small intestine so your doctor can see the shapes of these organs more clearly on x-rays.

You may have bloating and nausea for a short time after the test. For several days afterward, you may have white or light-colored stools from the barium. A health care professional will give you instructions about eating and drinking after the test.

Computerized tomography (CT) scan

A CT scan uses a combination of x-rays and computer technology to create images. For a CT scan, a health care professional may give you a solution to drink and an injection of a special dye, which doctors call contrast medium. You’ll lie on a table that slides into a tunnel-shaped device that takes the x-rays. An x-ray technician performs the procedure in an outpatient center or a hospital, and a radiologist interprets the images. You don’t need anesthesia.

CT scans can help diagnose a peptic ulcer that has created a hole in the wall of your stomach or small intestine.

Treatment

How do doctors treat peptic ulcer disease?

There are several types of medicines used to treat a peptic ulcer. Your doctor will decide the best treatment based on the cause of your peptic ulcer.

How do doctors treat an NSAID-induced peptic ulcer?

If NSAIDs are causing your peptic ulcer and you don’t have an H. pylori infection, your doctor may tell you to

  • stop taking the NSAID
  • reduce how much of the NSAID you take
  • switch to another medicine that won’t cause a peptic ulcer

Your doctor may also prescribe medicines to reduce stomach acid and coat and protect your peptic ulcer. Proton pump inhibitors (PPIs), histamine receptor blockers, and protectants can help relieve pain and help your ulcer heal.

PPIs

PPIs reduce stomach acid and protect the lining of your stomach and duodenum. While PPIs can’t kill H. pylori, they do help fight the H. pylori infection.

PPIs include

  • esomeprazole (Nexium)
  • dexlansoprazole (Dexilant)
  • lansoprazole (Prevacid)
  • omeprazole (Prilosec, Zegerid)
  • pantoprazole (Protonix)
  • rabeprazole (AcipHex)

Histamine receptor blockers

Histamine receptor blockers work by blocking histamine, a chemical in your body that signals your stomach to produce acid. Histamine receptor blockers include

  • cimetidine (Tagamet)
  • famotidine (Pepcid)
  • ranitidine (Zantac)
  • nizatidine (Axid) Protectants

Protectants

Protectants coat ulcers and protect them against acid and enzymes so that healing can occur. Doctors only prescribe one protectant—sucralfate (Carafate)—for peptic ulcer disease.

Tell your doctor if the medicines make you feel sick or dizzy or cause diarrhea or headaches. Your doctor can change your medicines.

If you smoke, quit. You also should avoid alcohol. Drinking alcohol and smoking slow the healing of a peptic ulcer and can make it worse.

What if I still need to take NSAIDs?

If you take NSAIDs for other conditions, such as arthritis, you should talk with your doctor about the benefits and risks of using NSAIDs. Your doctor can help you determine how to continue using an NSAID safely after your peptic ulcer symptoms go away. Your doctor may prescribe a medicine used to prevent NSAID-induced ulcers called Misoprosotol.

Tell your doctor about all the prescription and over-the-counter medicines you take. Your doctor can then decide if you may safely take NSAIDs or if you should switch to a different medicine. In either case, your doctor may prescribe a PPI or histamine receptor blocker to protect the lining of your stomach and duodenum.

If you need NSAIDs, you can reduce the chance of a peptic ulcer returning by

  • taking the NSAID with a meal
  • using the lowest effective dose possible
  • quitting smoking
  • avoiding alcohol

How do doctors treat an NSAID-induced peptic ulcer when you have an H. pylori infection?

If you have an H. pylori infection, a doctor will treat your NSAID-induced peptic ulcer with PPIs or histamine receptor blockers and other medicines, such as antibiotics, bismuth subsalicylates, or antacids.

PPIs reduce stomach acid and protect the lining of your stomach and duodenum. While PPIs can’t kill H. pylori, they do help fight the H. pylori infection.

PPIs include

Histamine receptor blockers

Histamine receptor blockers work by blocking histamine, a chemical in your body that signals your stomach to produce acid. Histamine receptor blockers include

Antibiotics

A doctor will prescribe antibiotics to kill H. pylori. How doctors prescribe antibiotics may differ throughout the world. Over time, some types of antibiotics can no longer destroy certain types of H. pylori.

Antibiotics can cure most peptic ulcers caused by H. pylori or H. pylori-induced peptic ulcers. However, getting rid of the bacteria can be difficult. Take all doses of your antibiotics exactly as your doctor prescribes, even if the pain from a peptic ulcer is gone.

Bismuth subsalicylates

Medicines containing bismuth subsalicylate, such as Pepto-Bismol, coat a peptic ulcer and protect it from stomach acid. Although bismuth subsalicylate can kill H. pylori, doctors sometimes prescribe it with antibiotics, not in place of antibiotics.

Antacids

An antacid may make the pain from a peptic ulcer go away temporarily, yet it will not kill H. pylori. If you receive treatment for an H. pylori-induced peptic ulcer, check with your doctor before taking antacids. Some of the antibiotics may not work as well if you take them with an antacid.

Various antacids are shown in this picture without any brand names (left to right): chewable tablets, pink liquid, and ingestible pills.
Check with your doctor before taking antacids while your ulcers are healing.

How do doctors treat an H.pylori-induced peptic ulcer?

Doctors may prescribe triple therapy, quadruple therapy, or sequential therapy to treat an H. pylori-induced peptic ulcer.

Triple therapy

For triple therapy, your doctor will prescribe that you take the following for 7 to 14 days:

Quadruple therapy

For quadruple therapy, your doctor will prescribe that you take the following for 14 days:

  • a PPI
  • bismuth subsalicylate
  • the antibiotics tetracycline and metronidazole

Doctors prescribe quadruple therapy to treat patients who

  • can’t take amoxicillin because of an allergy to penicillin. Penicillin and amoxicillin are similar.
  • have previously received a macrolide antibiotic, such as clarithromycin.
  • are still infected with H. pylori after triple therapy treatment.

Doctors prescribe quadruple therapy after the first treatment has failed. In the second round of treatment, the doctor may prescribe different antibiotics than those that he or she prescribed the first time.

Sequential therapy

For sequential therapy, your doctor will prescribe that you take the following for 5 days:

  • a PPI
  • amoxicillin

Then the doctor will prescribe you the following for another 5 days:

Triple therapy, quadruple therapy, and sequential therapy may cause nausea and other side effects, including

  • an altered sense of taste
  • darkened stools
  • a darkened tongue
  • diarrhea
  • headaches
  • temporary reddening of the skin when drinking alcohol
  • vaginal yeast infections

Talk with your doctor about any side effects that bother you. He or she may prescribe you other medicines.

How do doctors treat peptic ulcers caused by ZES?

Doctors use medicines, surgery, and chemotherapy to treat Zollinger-Ellison syndrome. Learn more about Zollinger-Ellison syndrome treatment.

What if a peptic ulcer doesn't heal?

Most often, medicines heal a peptic ulcer. If an H. pylori infection caused your peptic ulcer, you should finish all of your antibiotics and take any other medicines your doctor prescribes. The infection and peptic ulcer will heal only if you take all medicines as your doctor prescribes.

When you have finished your medicines, your doctor may do another breath or stool test in 4 weeks or more to be sure the H. pylori infection is gone. Sometimes, H. pylori bacteria are still present, even after you have taken all the medicines correctly. If the infection is still present, your peptic ulcer could return or, rarely, stomach cancer could develop. Your doctor will prescribe different antibiotics to get rid of the infection and cure your peptic ulcer.

Can a peptic ulcer come back?

Yes, a peptic ulcer can come back. If you smoke or take NSAIDs, peptic ulcers are more likely to come back. If you need to take an NSAID, your doctor may switch you to a different medicine or add medicines to help prevent a peptic ulcer. Peptic ulcer disease can return, even if you have been careful to reduce your risk.

How can I prevent a peptic ulcer?

To help prevent a peptic ulcer caused by NSAIDs, ask your doctor if you should

  • stop using NSAIDs
  • take NSAIDs with a meal if you still need NSAIDs
  • take a lower dose of NSAIDs
  • take medicines to protect your stomach and duodenum while taking NSAIDs
  • switch to a medicine that won’t cause ulcers

To help prevent a peptic ulcer caused by H. pylori, your doctor may recommend that you avoid drinking alcohol.

Eating, Diet, & Nutrition

How can your diet help prevent or relieve a peptic ulcer?

Researchers have not found that diet and nutrition play an important role in causing or preventing peptic ulcers. Before acid blocking drugs became available, milk was used to treat ulcers. However, milk is not an effective way to prevent or relieve a peptic ulcer.

Alcohol and smoking do contribute to ulcers and should be avoided.

​​​​

Clinical Trials

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support basic and clinical research into many digestive disorders.

What are clinical trials and are they right for you?

Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you.

What clinical trials are open?

Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov.​

November 2014
Share

This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings through its clearinghouses and education programs to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.