A burning pain in the upper abdomen is often described simply as an "ulcer." But abdominal pain alone cannot tell you whether you actually have a peptic ulcer.
Peptic ulcer disease occurs when an open sore develops in the lining of the stomach or duodenum, the first part of the small intestine.
Two causes are particularly important: infection with Helicobacter pylori (H. pylori) and the use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen and aspirin.
Some ulcers cause little or no discomfort. Others cause upper abdominal pain, nausea or early fullness. Complicated ulcers can bleed, perforate the stomach or intestinal wall, or obstruct the passage of food.
Understanding the cause matters because treating symptoms without addressing the underlying problem can allow an ulcer to return.
What Is a Peptic Ulcer?
A peptic ulcer is a sore in the lining of the stomach or duodenum.
There are two main types:
Gastric ulcer: develops in the stomach.
Duodenal ulcer: develops in the duodenum.
Peptic ulcers can lead to serious complications including gastrointestinal bleeding, perforation and blockage.
Is an oesophageal ulcer a peptic ulcer?
The old version of this article included the oesophagus in the definition of peptic ulcer disease.
For a clearer modern patient guide, it is better to focus on gastric and duodenal ulcers. Ulcers can occur in the oesophagus, but they are generally discussed separately and may have different causes.
What Causes Peptic Ulcers?
One of the biggest misconceptions about ulcers is that they are primarily caused by spicy foods or stress.
They aren't.
The two most common causes are:
H. pylori infection
NSAID use
1. H. pylori Infection
Helicobacter pylori is a bacterium that can infect the stomach.
The infection can cause inflammation and damage protective mechanisms in the stomach and duodenum, increasing the risk of an ulcer.
Many people with H. pylori do not know they have it.
When H. pylori is identified in a person with peptic ulcer disease, treating the infection is an important part of preventing recurrence.
2. NSAID Painkillers
NSAIDs include medicines such as:
ibuprofen;
naproxen; and
aspirin.
These medicines are useful for pain, inflammation and several medical conditions, but they can damage the protective lining of the stomach and duodenum.
Risk can be higher with prolonged use, higher doses, some combinations of medicines, previous ulcers and simultaneous H. pylori infection.
If you take aspirin for a medical reason such as cardiovascular disease, do not stop it on your own because you are worried about an ulcer. Discuss the risks and alternatives with the healthcare professional managing your treatment.
Other Causes
Less commonly, ulcers may be associated with other infections, certain medicines and diseases that cause excessive acid production, such as Zollinger-Ellison syndrome.
Doctors may investigate uncommon causes when an ulcer repeatedly returns or does not heal despite appropriate treatment.
Do Stress and Spicy Foods Cause Ulcers?
This deserves a clear answer because the misconception remains common.
Spicy foods are not considered a major cause of peptic ulcers.
Stress from ordinary daily life is also not considered one of the two major causes of typical peptic ulcer disease.
However, some foods or drinks may worsen symptoms in individual people.
If a particular food repeatedly makes your abdominal discomfort worse, avoiding or reducing that food may help you feel better. That is different from claiming that the food caused the ulcer.
Current NIDDK guidance states that researchers have not found diet and nutrition to play an important role in causing, preventing or treating peptic ulcers, and a special ulcer diet is not routinely recommended.
Symptoms of Peptic Ulcer Disease
Some people with peptic ulcers have no symptoms.
When symptoms occur, the most common is pain or discomfort in the upper abdomen.
The pain may feel:
burning;
dull;
aching; or
uncomfortable.
It may come and go.
For some people, discomfort occurs when the stomach is empty or during the night and temporarily improves after eating.
For others, eating makes the pain worse.
Other possible symptoms include:
feeling full unusually quickly;
uncomfortable fullness after meals;
nausea;
vomiting;
bloating; and
belching.
These symptoms are not specific to ulcers. Gastritis, indigestion and several other gastrointestinal conditions can produce similar symptoms.
That is why persistent abdominal symptoms should not automatically be self-diagnosed as an ulcer.
Warning Signs: When an Ulcer May Be an Emergency
Peptic ulcers can sometimes cause serious complications.
Seek urgent medical attention if you develop:
black, tarry stool;
red or maroon blood in stool;
vomiting blood;
vomit that resembles coffee grounds;
sudden severe abdominal pain that does not go away;
fainting or significant dizziness; or
symptoms suggesting shock.
These may indicate significant gastrointestinal bleeding or another serious ulcer complication.
Complications of Peptic Ulcers
Gastrointestinal Bleeding
An ulcer can damage a blood vessel.
Slow bleeding may contribute to anaemia, while severe bleeding can become a medical emergency.
Perforation
An ulcer can create a hole through the stomach or duodenal wall.
This can allow gastrointestinal contents to enter the abdominal cavity and can cause a serious infection.
Penetration
An ulcer may extend through the stomach or duodenal wall into a nearby organ.
Gastric Outlet Obstruction
Inflammation or scarring can interfere with food leaving the stomach.
These complications require medical assessment and may require endoscopic procedures, hospital treatment or surgery.
How Is Peptic Ulcer Disease Diagnosed?
Diagnosis starts with your symptoms, medical history and medicines.
A healthcare professional may specifically ask whether you use:
ibuprofen;
aspirin;
naproxen;
other NSAIDs; or
medicines that can increase gastrointestinal bleeding risk.
Testing may then be needed to determine whether an ulcer is present and whether H. pylori is involved.
H. pylori Testing
Several methods can detect H. pylori.
Urea Breath Test
The urea breath test can detect active H. pylori infection.
After swallowing specially labelled urea, your breath is analysed for evidence that H. pylori has broken it down.
Stool Antigen Test
A stool test can detect H. pylori antigens.
Stool testing can also be used after treatment to determine whether the infection has been successfully eradicated.
Blood Tests
Blood tests can detect antibodies associated with H. pylori exposure, but antibody testing has limitations because antibodies may remain after an infection has been successfully treated.
For this reason, tests that can identify active infection, such as the urea breath test or stool antigen test, are particularly useful in appropriate patients.
Upper GI Endoscopy
During an upper gastrointestinal endoscopy, a flexible instrument with a camera is passed through the mouth to examine the oesophagus, stomach and duodenum.
Endoscopy can:
identify an ulcer;
determine its location;
assess bleeding;
identify suspicious abnormalities; and
allow tissue samples to be collected.
A biopsy may also be used to test for H. pylori or investigate other conditions.
Not everyone with indigestion needs an endoscopy. The decision depends on symptoms, age, medical history, warning signs and clinical judgement.
How Are Peptic Ulcers Treated?
Treatment has two goals:
heal the ulcer and treat its underlying cause.
Simply reducing stomach acid without addressing H. pylori or problematic NSAID use may not adequately prevent recurrence.
Proton Pump Inhibitors
Proton pump inhibitors, commonly called PPIs, reduce stomach-acid production and allow damaged tissue to heal.
A healthcare professional determines the appropriate medicine and treatment duration according to the cause and clinical circumstances.
Treating H. pylori
H. pylori requires combination treatment.
Treatment generally includes an acid-suppressing medicine together with multiple antimicrobial medicines, with the exact regimen depending on factors such as antibiotic resistance, previous antibiotic exposure, allergies and local clinical guidance.
This is one area where the old AnjKreb article needed an important correction.
There isn't one antibiotic combination that every reader should simply copy and take.
Antibiotic resistance matters.
The 2024 American College of Gastroenterology guideline, for example, advises against empirically using certain clarithromycin or levofloxacin-containing regimens unless susceptibility has been demonstrated. (American College of Gastroenterology)
Do not self-treat H. pylori with antibiotics.
Incorrect antibiotic use can fail to eradicate the infection and contribute to antimicrobial resistance.
Confirming That H. pylori Is Gone
Feeling better does not necessarily prove that H. pylori has been eradicated.
Current ACG guidance recommends confirming eradication after treatment using an appropriate test such as:
a urea breath test;
stool antigen test; or
an appropriate biopsy-based test.
Testing should be performed at least four weeks after antibiotic treatment, with certain medicines temporarily withheld when clinically appropriate because they can affect test accuracy. (American College of Gastroenterology)
Your healthcare professional should tell you how to prepare for the test rather than stopping prescribed medicines independently.
Treating NSAID-Associated Ulcers
If NSAIDs contributed to an ulcer, a healthcare professional may consider:
stopping the NSAID when medically appropriate;
reducing the dose;
changing the medicine;
using an alternative pain treatment; or
adding acid-suppressing treatment when NSAID therapy must continue.
The decision depends on why the medicine is being used and the patient's individual risks.
Again, do not independently stop medically necessary aspirin or another prescribed medicine without discussing it with the clinician managing your care.
What Should You Eat When You Have an Ulcer?
There is no scientifically established universal ulcer diet.
You generally do not need to eliminate every spicy food, coffee or other commonly blamed food simply because you have peptic ulcer disease.
Instead:
eat a nutritionally balanced diet;
notice whether particular foods consistently worsen your symptoms;
avoid foods that clearly cause discomfort for you; and
follow any individual dietary instructions given by your healthcare professional.
Diet should support general health, but H. pylori infection requires appropriate eradication treatment, and an NSAID-related ulcer requires the medication issue to be addressed.
Food alone cannot eradicate H. pylori.
What About Alcohol?
Heavy alcohol consumption can irritate and damage the gastrointestinal lining and may worsen symptoms.
If alcohol aggravates your symptoms, avoiding it is sensible.
Alcohol should not, however, distract from investigating the major causes of peptic ulcer disease.
Smoking and Peptic Ulcers
Smoking is associated with peptic ulcer risk and can interfere with healing.
If you smoke, stopping is beneficial for your overall health and may help reduce ulcer-related risks.
Can Peptic Ulcers Come Back?
Yes.
Recurrence is more likely if the underlying cause remains.
For example:
H. pylori was not successfully eradicated;
problematic NSAID exposure continues;
smoking continues;
treatment was not completed; or
an uncommon underlying condition has not been identified.
This is why identifying the cause is just as important as healing the sore.
Peptic Ulcer vs Gastritis: Are They the Same?
No.
They are related but different.
Gastritis refers to inflammation of the stomach lining.
Peptic ulcer disease involves a deeper open sore in the stomach or duodenal lining.
H. pylori and NSAIDs can be involved in both conditions, which is one reason their symptoms can overlap.
A person cannot reliably distinguish the two based on symptoms alone.
Frequently Asked Questions
What is the main cause of stomach ulcers?
H. pylori infection and NSAID use are the two most common causes of peptic ulcers.
Does spicy food cause ulcers?
Spicy food is not considered a major cause of peptic ulcer disease. However, it may worsen symptoms in some people.
Can stress cause an ulcer?
Ordinary psychological stress is not considered one of the main causes of typical peptic ulcers. H. pylori and NSAIDs are much more important.
Severe physiological stress associated with critical illness, major injury, burns or sepsis can contribute to stress-related stomach injury in seriously ill patients, which is a different clinical situation.
How do I know whether I have H. pylori?
H. pylori can be investigated using tests such as a urea breath test, stool antigen test or biopsy obtained during endoscopy.
Can H. pylori be cured?
Yes. Appropriate combination treatment can eradicate H. pylori. Testing after treatment is important to confirm that eradication was successful.
Can ulcers heal without treatment?
Symptoms may improve, but an untreated underlying cause can allow an ulcer to persist, recur or develop complications.
If you suspect an ulcer, proper assessment is safer than repeatedly treating symptoms yourself.
Are antacids enough to cure an ulcer?
Antacids can provide temporary symptom relief by neutralising stomach acid, but they do not eradicate H. pylori or address all causes of peptic ulcer disease.
Can ibuprofen cause an ulcer?
Yes. Ibuprofen belongs to the NSAID group of medicines, one of the two major causes of peptic ulcers.
Can ulcers cause cancer?
A peptic ulcer itself should not simply be described as "turning into cancer."
However, some gastric cancers can resemble stomach ulcers, and long-term H. pylori infection is an important risk factor for gastric cancer. This is one reason appropriate evaluation of suspicious or persistent gastric ulcers matters.
When Should You See a Healthcare Professional?
Seek medical assessment if you have persistent or recurring upper abdominal symptoms, particularly if symptoms are worsening or interfering with eating.
Urgent assessment is particularly important for:
black or bloody stool;
vomiting blood;
severe persistent abdominal pain;
fainting or marked dizziness;
persistent vomiting; or
other signs suggesting gastrointestinal bleeding or a serious complication.
The Bottom Line
Peptic ulcer disease is an open sore in the stomach or duodenal lining.
The two major causes are H. pylori infection and NSAID use, not simply stress or spicy food.
Treatment therefore depends on identifying the cause.
H. pylori requires appropriate combination therapy followed by confirmation that the infection has been eradicated. NSAID-associated ulcers require review of the medicines contributing to the problem, while acid-suppressing treatment such as a PPI may be used to promote healing.
Most ulcers can be treated successfully.
The most important things are proper diagnosis, treatment of the underlying cause and rapid medical attention if bleeding or other complications develop.
References and Further Reading
NIDDK: Symptoms and Causes of Peptic Ulcers
NIDDK: Diagnosis of Peptic Ulcers
NIDDK: Treatment for Peptic Ulcers
American College of Gastroenterology: 2024 H. pylori Guideline Highlights
No comments:
Post a Comment