Skip to main content

Peptic Ulcers

Medically reviewed by Carmen Fookes, BPharm. Last updated on May 4, 2021.

Peptic ulcers are small holes or erosions that occur in the lining of your stomach or duodenum. There are two types of peptic ulcers:

  • Gastric ulcers: These occur in the lining of your stomach
  • Duodenal ulcers: These occur in the lining of your duodenum. Your duodenum is the first part of your small intestine, immediately beyond your stomach, and it is responsible for a lot of food digestion and drug absorption.

What causes a peptic ulcer and who is more at risk?

Our stomach and duodenum are lined with a mucus-producing inner layer known as the mucosa. This layer is delicate and its integrity depends on a careful balance of protective factors (such as the production of mucus) and destructive factors (such as acid production).

Disruption of this balance can result in a break in this protective layer, causing a peptic ulcer. Disruptions may occur as a result of:

  • Excessive acid production
  • Excessive alcohol consumption (stimulates acid production)
  • Infection, particularly with a common stomach bacterium known as Helicobacter Pylori
  • Medications NSAIDs  (eg, aspirin, ibuprofen, diclofenac, ketoprofen)
  • Other conditions, such as liver disease, Crohn’s disease, or Zollinger-Ellison syndrome
  • Physical stress, such as major surgery or burns.

Although everyday stress (emotional stress) doesn’t appear to cause ulcers, it may make the pain worse. The risk of getting an ulcer is also increased in people who smoke and coffee has been known to stimulate acid production in the stomach and make ulcers worse. People with a family history of peptic ulcers or with blood type O are also more prone to duodenal ulcers.

What are the symptoms of a peptic ulcer?

Symptoms vary from person to person, and some people may have no symptoms at all. Abdominal pain is common, and that associated with duodenal ulcers tends to be relieved by food (although worsened by alcohol or coffee), whereas that associated with gastric ulcers tends to worsen after food. Other common symptoms include:

  • Bloating or belching
  • Blood in the vomit or stools or dark tarry stools
  • Chest pain
  • Heartburn or indigestion
  • Nausea or vomiting
  • Tiredness
  • Weight gain (more common with duodenal ulcers) or weight loss (more common with gastric ulcers).

Duodenal ulcers are more likely to cause abdominal pain at night. Symptoms such as vomiting, severe pain, or blood in the stools are rare with peptic ulcers and should be reported to your doctor.

Most ulcers occur in the first layer of the inner lining. A hole that goes all the way through is called a perforation of the intestinal lining and will cause severe pain and bleeding. It is a medical emergency.

How is a peptic ulcer diagnosed?

To help diagnose a peptic ulcer, your doctor will ask you what medications you take or have been taking, and if you have had a peptic ulcer or any other relevant condition in the past. Make sure you mention all the medications you are taking, especially NSAIDs such as aspirin, ibuprofen, diclofenac, or ketorolac.

Your doctor will also conduct a physical examination, to check for bloating or lumps within your abdomen, and to listen for bowel sounds. Make sure you mention any areas of pain or tenderness.

Blood may also be taken to test for infection or anemia and testing is also conducted for H. pylori, which usually involves either a breath test, stool sample, or biopsy. To get a clear picture of the inside of your stomach and small intestines, doctors may use an endoscope (a small thin tube with a camera on the end, a series of X-rays (called an upper GI series), and/or a CT scan.

Call your doctor if:

Call your doctor if you have ulcer symptoms or have blood in your stool (especially if maroon or dark, tarry black).

Call 911 if you:

Call 911 if you:

  • Suddenly develop sharp abdominal pain
  • Have symptoms of shock like fainting, excessive sweating, or confusion
  • Are vomiting blood 
  • Have a rigid, hard abdomen that is tender to touch.

How is a peptic ulcer treated?

Treatment for peptic ulcers usually involves a combination of medications which reduce acid secretion, protect the mucosa, and kill H. pylori bacteria (if present).

This allows ulcers to heal and reduces the chance of them will come back. All medications should be taken exactly as prescribed.

Examples of medications that may be considered to treat peptic ulcers include:

  • Antibiotics to kill H. pylori (usually two or three different antibiotics are taken in combination for one to two weeks)
  • H2 receptor blockers that reduce stomach acid production (like cimetidine or famotidine)
  • Proton pump inhibitors to block stomach acid production (such as esomeprazole, lansoprazole, omeprazole, or pantoprazole)
  • Protectants that coat the ulcer and protect it against acid and enzymes, enhancing healing (like sucralfate)
  • Bismuth (may help protect the lining and kill the bacteria).

Occasionally, surgery may be needed to stop bleeding or to fix ulcers completely.

If NSAIDs have caused your peptic ulcer, your doctor may advise you to stop taking them, reduce their dosage, or switch to an alternative medicine. Follow his/her advice. Talk to your doctor before taking antacids as these may reduce the absorption of some other medications.

How can I prevent a peptic ulcer from developing? 

  • Don't smoke or chew tobacco.
  • Limit alcohol.
  • Do not take more than the recommended dose of aspirin, diclofenacibuprofen, or naproxen or take these medications for long periods of time, unless you are under the supervision of a health professional. Try acetaminophen instead.
  • Eat a well-balanced, healthy diet. Avoid late-night snacks or overeating.
  • Reduce stress.

See Also

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.