What Causes Ulcers?

Medical Author: Melissa Stöppler, M.D.
Medical Editor: Jay W. Marks, MD

A peptic ulcer is an area of damage to the inner lining of the stomach, esophagus, or duodenum (the first part of the small intestine). Over 25 million Americans will have a peptic ulcer at some point in their lifetime. People of all ages can suffer from ulcers. Men and women are equally affected.

Peptic ulcers were formerly thought to be caused by stress, coffee consumption, or spicy foods. Now it is clear that about 60% of peptic ulcers are caused by a bacterial infection that can usually be cured. Another 20% are caused by nonsteroidal antiinflammatory drugs (NSAIDs) such as aspirin and ibuprofen (Advil, Nuprin, etc.), and another 20% have miscellaneous causes such as cigarettes or no clear cause.

The bacterium Helicobacter pylori (H. pylori) was established as the leading cause of peptic ulcers in the early 1980s. It was also found to cause gastritis (inflammation of the stomach lining), and, in Asian populations, cancer of the stomach.

H. pylori is a spiral-shaped bacterium that can live and grow on the lining tissues of the stomach. Some people can be infected with H. pylori and never develop an ulcer or show any symptoms of the infection. In other people, the organism may persist for years before any symptoms develop.

It remains unclear why some people develop symptoms of the infection and others do not. It is also not clear exactly how H. pylori is transmitted from person to person. In the United States, H. pylori infection is more common among the elderly, African-Americans, Hispanics, and in those living under lower socioeconomic conditions.

Most commonly, ulcers related to H. pylori are treated with a two week course of treatment called triple therapy, consisting of two antibiotics to kill the bacteria and either an acid suppressor or stomach-lining shield medication. Omeprazole (Prilosec) and lansoprazole (Prevacid) are common proton pump inhibitors that are often administered with the antibiotics. Proton pump inhibitors interrupt the mechanism that produces stomach acid. A bismuth preparation (such as Pepto-Bismol) is sometimes given as a stomach-lining shield. Although acid suppressing drugs will heal the ulcers, unless antibiotics also are administered, up to 80% of ulcers recur, in contrast to about 6% when the H. pylori infection is treated with antibiotics.

Tests for H. pylori infection include upper endoscopy in which a long flexible tube with a light and camera on the end is passed through the mouth, down the esophagus and into the stomach for examination of the esophagus, stomach, and duodenum. With endoscopy, the diagnosis of an ulcer can be made and a biopsy removed and examined for the presence of H. pylori.

Noninvasive tests cannot determine if an ulcer is present but may be used to diagnose H. pylori infection. These include blood tests to identify antibodies to H. pylori, the urea breath test (UTB), and a test on samples of stool that also identifies antibodies. For the urea breath test, an oral preparation of urea containing radiolabeled carbon is given. H. pylori in the stomach metabolize (break up) the urea and the resulting radioactive carbon portion of the urea is absorbed into the blood stream and ultimately exhaled in the breath. The exhaled breath is tested for radioactive carbon, indicating the H. pylori infection.

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eMedicine.com; "Gastric Ulcers."