What causes peptic ulcers?

Peptic ulcer disease is when a sore forms on the inner lining of the stomach or small intestine. Test yourself for an ulcer with lab tests, imaging tests, and an endoscopy.
Peptic ulcer disease is when a sore forms on the inner lining of the stomach or small intestine. Test yourself for an ulcer with lab tests, imaging tests, and an endoscopy.

Peptic ulcer disease is when a sore forms on the inner lining of the stomach or small intestine. When a peptic ulcer is found in the stomach, it’s called a stomach ulcer or gastric ulcer. When it is found in the duodenum or where the small intestine starts, it’s called a duodenal ulcer.

Ulcers are painful and can cause complications if left untreated. But, how do you know when you have an ulcer? Here’s all you need to know about peptic ulcer symptoms, diagnosis, and treatment. 

Peptic ulcers occur due to Helicobacter pylori (H. pylori) infection. H. pylori is a bacteria that lives in the gut, but it can also infect your stomach. Non-steroidal anti-inflammatory drugs or NSAIDs like ibuprofen, aspirin, naproxen, or diclofenac can also cause ulcers. You can also get stomach ulcers if you eat very spicy food or have too much alcohol. Sometimes, stress and smoking can increase your risk of developing stomach ulcers. 

All these factors weaken the stomach lining. The stomach acid that helps digest food further damages the weak stomach lining. This causes a stomach ulcer. 

Diseases like Zollinger-Ellison syndrome and multiple endocrine neoplasia can also cause peptic ulcers. These diseases cause stomach tumors and excess hormone levels, which can increase stomach acid production and cause peptic ulcers.

How do you know if you have an ulcer?

Peptic ulcers cause burning pain in your stomach. Stomach pain can start when your stomach is empty between meals or at night. It can also start after eating. It typically lasts from a few minutes to hours.

Antacids or medicines for indigestion may relieve the pain for some time, but if you don’t treat the ulcer, the pain may return. Other peptic ulcer symptoms include:

How do you check for an ulcer?

If you think you have peptic ulcer symptoms, visit your doctor. They’ll check your medical history and your symptoms. They’ll ask you about medicines you take, especially NSAIDs. They’ll do a physical exam to check for stomach pain and bloating. They’ll order some lab tests to check for ulcers. 

Peptic ulcer diagnosis can follow:

Laboratory tests

Your doctor will do lab tests for peptic ulcer diagnosis. They may measure gastrin levels in your blood. Gastrin is a hormone that helps release stomach acid or digestive juices. 

They’ll also check for H. pylori infection using these tests:

  • Urea breath test. Your doctor will ask you to drink a liquid containing urea — a waste product formed when protein breaks down in your body. H. pylori bacteria convert urea into carbon dioxide, which is the gas you breathe out. Your doctor will collect your breath sample. If you have an H. pylori infection in your stomach, your breath will have higher levels of carbon dioxide. 
  • Blood test. A blood test can help detect H. pylori infection.
  • Stool test. Doctors use a stool test to detect H. pylori infection. They’ll check if your stool sample has the bacteria. 

X-ray

Doctors use x-ray tests like barium contrast radiography or upper gastrointestinal (GI) series to check for digestive tract problems. You’ll have to swallow a contrast solution called barium, which coats your digestive tract. This helps your doctor see the shape of your stomach and small intestines on x-rays. The doctor will then take a series of x-ray images to detect peptic ulcers. 

You may feel bloated and nauseous after the test. For a few days, you may have white or light-colored stools because of barium.

Computerized tomography or CT scan

A CT scan uses x-rays and computers to create images of your body. Your doctor will ask you to drink a solution called the contrast medium. You’ll then lie inside the CT machine, which will take x-rays of your body. The images will appear on the computer. Your doctor will check the images for peptic ulcer diagnosis.

Endoscopy

Your doctor may use gastrointestinal endoscopy along with a biopsy to diagnose peptic ulcer disease. Endoscopy and biopsy are parts of the same procedure:

Endoscopy. An endoscope is a flexible tube with a camera attached to its end. The doctor will insert the endoscope into the stomach through your mouth. The camera allows your doctor to closely check the stomach lining for peptic ulcers. 

Biopsy. The doctor will insert a biopsy tool through the endoscope. It helps your doctor get a sample of the stomach cells to test for infection or disease in the lab.

You’ll have to visit a hospital or healthcare facility for this procedure. Your doctor will give you anesthesia before the endoscopy.

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How to treat peptic ulcers?

Ulcers usually heal in a few months. Depending on the cause, doctors use the following treatments for peptic ulcers:

Antacids.  Antacids are medicines that calm the stomach acid and help relieve your symptoms temporarily.

Triple therapy. Doctors usually prescribe triple therapy twice daily for 7 to 10 days. It includes antibiotics amoxicillin and clarithromycin or levofloxacin and a drug called a proton pump inhibitor (PPI), which decreases stomach acid production. This therapy is used to remove H. pylori from your stomach.

Sequential therapy. This treatment involves taking a PPI and amoxicillin twice daily for 5 days. After this, you’ll have to take a 5-day course of a PPI and the antibiotics clarithromycin and metronidazole or tinidazole twice daily.

Non-bismuth-based quadruple therapy. This involves triple therapy along with metronidazole or tinidazole.

Bismuth-based quadruple therapy. This involves non-bismuth-based quadruple therapy plus a bismuth salt.

NSAIDs. If your stomach ulcer is not caused by NSAIDs, you can take them for pain relief. If you have ulcers due to NSAIDs, your doctor will give you PPIs or paracetamol.

Alternative medication. Your doctor may ask you to take histamine H2 receptor antagonists, which are like PPIs. They may also recommend cyclooxygenase-2 (COX-2) inhibitors instead of painkillers.

Lifestyle changes. Your doctor will advise you to control stress, alcohol intake, spicy food intake, and smoking to let your ulcers heal.

What are the complications of peptic ulcer disease?

If left untreated, peptic ulcer disease can lead to complications like:

  • Internal bleeding or hemorrhage 
  • Perforation or the ulcer burning through the stomach lining
  • Pyloric stenosis — when the pylorus or opening of the stomach into the small intestine becomes narrow

It’s best to seek immediate peptic ulcer diagnosis and treatment to prevent complications. 

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Medically Reviewed on 4/28/2022
References
Sources:

American Family Physician: "Diagnosis and Treatment of Peptic Ulcer Disease and H. pylori Infection."

John Hopkins Medicine: "Peptic Ulcer Disease," "Peptic Ulcer Disease Treatment."

National Institute of Diabetes and Digestive and Kidney Diseases: "Diagnosis of Peptic Ulcers (Stomach Ulcers)," "Symptoms & Causes of Peptic Ulcers (Stomach Ulcers)."

NHS: "Causes," "Diagnosis," "Symptoms," "Treatment."