Peptic Ulcer: Symptoms, Causes, and Treatment

Peptic ulcers are open sores that grow on the inside lining of your stomach and the upper portion of your small intestine. Most people with peptic ulcers don’t have symptoms. The most common symptom of a peptic ulcer is stomach pain.

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Peptic ulcers include:

  • Gastric ulcersthat occur on the inside of the stomach
  • Duodenal ulcersthat occur on the inside of the upper portion of your small intestine (duodenum)

The most common causes of peptic ulcers are infection with the bacterium Helicobacter pylori (H. pylori) and long-term use of aspirin and certain other painkillers. Note that stress and spicy foods do not cause peptic ulcers but they can worsen your symptoms.

Symptoms of Peptic ulcer

The most common peptic ulcer symptom is burning stomach pain. An empty stomach aggravates the pain. The pain can often be eased by eating certain foods that buffer stomach acid or by taking an acid-reducing drug, but then it may come back. The pain may deteriorate between meals and at night.

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Less often, ulcers may cause severe signs or symptoms such as:

When to see a doctor

See your doctor if you have signs or symptoms listed above. Also see your doctor if OTC antacids and acid blockers ease your pain but the pain returns.

Causes of Peptic ulcer

Peptic ulcers occur when acid in the digestive tract eats away at the inner surface of the stomach or small intestine, creating a painful open sore that may bleed.

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Your digestive tract is coated with a mucous layer that usually protects against acid. However, a person may develop an ulcer if the amount of acid is increased or the amount of mucus is decreased. Common causes include:

  • A bacterium.Helicobacter pylori bacteria commonly live in the mucous layer that protects tissues that line the stomach and small intestine. The H. pylori bacterium causes no problems at times, but it can cause inflammation of the inner layer of the stomach, causing an ulcer.

It’s not certain how H. pylori infection spreads. It may be passed on from person to person by close contact, such as kissing or through food and water.

  • Regular use of certain pain relievers.Taking aspirin and pain medications called nonsteroidal anti-inflammatory drugs (NSAIDs) can irritate the lining of your stomach and small intestine. These medications include ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve, Anaprox, others), but not acetaminophen (Tylenol).

Peptic ulcers are more common in older adults who take these pain medications frequently or in people who take these medications for osteoarthritis.

  • Other medications.Taking certain other medications along with NSAIDs, such as steroids, anticoagulants, low-dose aspirin, selective serotonin reuptake inhibitors (SSRIs), alendronate (Fosamax) and risedronate (Actonel), can greatly increase the risks of developing ulcers.

Risk factors

In addition to taking certain pain medications, including aspirin, you may have an increased risk of peptic ulcers if you:

  • Smoking may upsurge the risk of peptic ulcers in people who are infected with H. pylori.
  • Drinking alcohol.Consuming alcohol can erode the mucous lining of your stomach, increasing the amount of stomach acid that is produced.
  • Having untreated stress
  • Eating spicy foods

Alone, these factors do not cause ulcers, but they can make them worse and more difficult to heal.


If left untreated, peptic ulcers can result in:

  • Internal bleedingBleeding can occur as slow blood loss that leads to anemia or as severe blood loss that may require hospitalization or a blood transfusion. Severe blood loss may cause black or bloody vomit or black or bloody stools.
  • Peptic ulcers can eat a hole through the wall of your stomach or small intestine, putting you at risk of serious infection of your abdominal cavity.
  • Peptic ulcers can lead to inflammation or scarring that may block passage of food through the digestive tract. A blockage may make you become full easily, vomit and lose weight.

READ ALSO: Gastrointestinal Perforation: Causes and Treatment


You may reduce your risk of peptic ulcer if you follow the same strategies recommended as home remedies to treat ulcers. It may also be helpful to:

  • Protect yourself from infections. pylori can be transmitted from person to person or through food and water. Take steps to protect yourself from infections, such as H. pylori, by washing your hands frequently with soap and water and by eating foods that have been properly cooked.
  • Use caution with pain relievers.If you regularly use pain relievers that increase your risk of peptic ulcer, take steps to reduce your risk of stomach problems by taking your medications with meals. Avoid drinking alcohol when taking your medications.


Your doctor may take a medical history and perform a physical exam. You then may need to undergo diagnostic tests, such as:

  • Laboratory tests for H. pylori. Your doctor may recommend tests using your stool, blood, or breath test to determine whether the bacterium H. pylori is present in your body. The breath test is the most accurate. Blood tests are generally inaccurate and should not be used.

For the breath test, you drink or eat something containing radioactive carbon. H. pylori breaks down the substance in your stomach. Later, you blow into a bag, which is then sealed. If you’re infected with H. pylori, your breath sample will contain the radioactive carbon in the form of carbon dioxide.

  • Your doctor may use a scope to examine your upper digestive system. During endoscopy, your doctor passes an endoscope (hollow tube equipped with a lens) down your throat and into your esophagus, stomach and small intestine.

Small tissues may be removed for examination in a lab if your doctor detects ulcer. A biopsy can also identify whether H. pylori is in your stomach lining.

  • Upper gastrointestinal series.This series of X-rays of your upper digestive system creates images of your gullet, stomach and small intestine. During the X-ray, you swallow a white liquid containing barium that coats your digestive tract and makes an ulcer more visible.


Treatment for peptic ulcers depends on the underlying cause. Treatment will involve killing the H. pylori bacterium, if present, eliminating or reducing use of aspirin and similar pain medications. Medications can include:

  • Antibiotic medications to kill H. pylori.If H. pylori is found in your digestive tract, your doctor may recommend a combination of antibiotics to kill the bacterium. These may include amoxicillin (Amoxil), clarithromycin (Biaxin), metronidazole (Flagyl), tinidazole (Tindamax), tetracycline (Tetracycline HCL) and levofloxacin (Levaquin).

The antibiotics used will be determined by where you live and current antibiotic resistance rates. You’ll likely need to take antibiotics for two weeks, as well as additional medications to reduce stomach acid, including a proton pump inhibitor and possibly bismuth subsalicylate (Pepto-Bismol).

  • Medications that block acid production and promote healing.Proton pump inhibitors — also called PPIs — reduce stomach acid by blocking the action of the parts of cells that produce acid. These drugs include the prescription and over-the-counter medications omeprazole (Prilosec), lansoprazole (Prevacid), rabeprazole (Aciphex), esomeprazole (Nexium) and pantoprazole (Protonix).

Long-term use of proton pump inhibitors, particularly at high doses, may increase your risk of hip, wrist and spine fracture. Ask your doctor whether a calcium supplement may reduce this risk.

  • Medications to reduce acid production. Acid blockers reduce the amount of stomach acid released into your digestive tract, which eases ulcer pain and boosts healing.

Acid blockers that are available by prescription and OTC include the medications ranitidine (Zantac), famotidine (Pepcid), cimetidine (Tagamet HB) and nizatidine (Axid AR).

  • Antacids that neutralize stomach acid.Your doctor may include an antacid in your drug regimen. Antacids neutralize existing stomach acid and can provide rapid pain relief. Side effects can include constipation or diarrhea, depending on the main ingredients. Antacids can provide symptom relief, but generally aren’t used to heal your ulcer.
  • Medications that protect the lining of your stomach and small intestine.In some cases, your doctor may prescribe medications called cytoprotective agents that help protect the tissues that line your stomach and small intestine.

Options include the prescription medications sucralfate (Carafate) and misoprostol (Cytotec).

Lifestyle and home remedies

You may find relief from the pain of a stomach ulcer if you:

  • Choose a healthy diet.Choose a healthy diet full of fruits, especially with vitamins A and C, vegetables, and whole grains. Not eating vitamin-rich foods may make it difficult for your body to heal your ulcer.
  • Consider foods containing probiotics.These include yogurt, aged cheeses, miso, and sauerkraut.
  • Consider eliminating milk.Sometimes drinking milk will make your ulcer pain better, but then later cause excess acid, which increases pain. Talk to your doctor about drinking milk.
  • Consider switching pain relievers.If you use pain relievers regularly, ask your doctor whether acetaminophen (Tylenol, others) may be an option for you.
  • Control stress.Stress may worsen the signs and symptoms of a peptic ulcer. Consider the sources of your stress and do what you can to address the causes. Some stress is unavoidable, but you can learn to cope with stress with exercise, spending time with friends or writing in a journal.
  • Don’t smoke.Smoking may interfere with the protective lining of the stomach, making your stomach more susceptible to the development of an ulcer. Smoking also increases stomach acid.
  • Limit or avoid alcohol.Excessive use of alcohol can irritate and erode the mucous lining in your stomach and intestines, causing inflammation and bleeding.
  • Try to get enough sleep.Sleep can help your immune system, and therefore counter stress. Also, avoid eating shortly before bedtime.

Alternative medicine

Peptic ulcers can be treated with over-the-counter drugs that contain calcium carbonate (Tums, Rolaids). However they should not be used as the primary treatment. There is also some evidence that zinc can help heal ulcers.

Among botanicals recommended to treat peptic ulcers are cabbage, turmeric, mastic, deglycyrrhizinated licorice, and neem bark extract.


Disclaimer: The content provided on is purely informative and educational in nature and should not be interpreted as medical advice. Please use the content only in consultation with an appropriate certified medical doctor or healthcare professional.


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