A peptic ulcer is a painful sore that forms in the stomach or the duodenum (dew-eh-DEE-num), the first part of the small intestine. Peptic ulcers found in the stomach are sometimes called gastric or stomach ulcers. Those found in the duodenum are sometimes called duodenal ulcers.
Digestive juices in the stomach contain hydrochloric acid, a very strong acid that is produced by parietal cells and secreted into the stomach. This acid helps to kill bacteria and viruses found in food and water and, along with the enzyme * pepsin, begins the process of digestion, or breakdown of food so that it can be absorbed into the bloodstream and used by the body. The inside of the stomach and duodenum are lined with a heavy layer of mucus. This mucus protects the stomach tissue from being destroyed by stomach acid. Peptic ulcers develop when there is damage to the mucus lining. Stomach acid then erodes (eats away at) the stomach tissue or duodenum. This condition causes inflammation * and can result in a peptic ulcer.
Peptic ulcers form because the mucus in the stomach and duodenum is unable to protect the tissue underneath it from destruction by stomach acid. Several conditions can upset the balance between mucus and stomach acid and make it likely that an ulcer will form.
Helicobacter pylori (HEEL-ih-ko-bak-ter pieLOR-eye) is a spiral-shaped bacterium that has adapted to living in the very acidic environment of the stomach. In order to survive, H. pylori burrows into the mucus lining the stomach. Once it gets into the mucus, it uses an enzyme to cause a chemical reaction that produces bicarbonate and ammonia. Both of these are strong bases that neutralize any stomach acid that reaches the bacterium. The immune system responds to the presence of H. pylori. Eventually the mucous lining is weakened and stomach acid can eat away at the tissue underneath, forming an ulcer or open sore.
In the United States, about 10 percent of children under age 12 are infected with H. pylori. This number increases with age until about half of all Americans over age 60 have the infection. The rate of infection is much higher in the developing world. Scientists are not exactly sure how the infection is passed from person to person, although they think that it is transmitted through contact with feces * from infected people or through drinking contaminated water. Some researchers also believe that H. pylori can be transmitted through kissing an infected person.
As of 2015, researchers did not fully understand the relationship between H. pylori, gastric inflammation, and peptic ulcers. For example, about 90 percent of people who have peptic ulcers are infected with H. pylori, but only a small number of those who are infected develop an ulcer, and 10 percent of people with ulcers do not have H. pylori infections. Also, antibiotic treatment to rid the body of H. pylori does not, by itself, cure most ulcers.
Nonsteroidal anti-inflammatory drugs (NSAIDS) are medications used to reduce inflammation and treat the pain it causes. Familiar NSAIDS are aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve). Long-term use of NSAIDS, for example to treat arthritis, can cause the mucous lining to weaken and allow an ulcer to form.
Certain lifestyle choices also make it more likely that a person will develop a peptic ulcer. These include heavy alcohol use, cigarette smoking, and heavy caffeine consumption.
People who experience severe injuries or burns, or who undergo major surgery, are more likely to develop an ulcer. Some researchers also believe that extreme anxiety and emotional distress can promote ulcer formation.
The most common symptom of a peptic ulcer is a gnawing or burning pain in the stomach. This pain comes and goes over a period of days or weeks, most often when the stomach is empty, for example, three or four hours after a meal or in the middle of the night. Eating may help relieve the pain. Other possible symptoms include weight loss, poor appetite, bloating, burping, nausea, and vomiting.
If a person has lasting abdominal pain or other symptoms of peptic ulcer disease, there are several methods a doctor can use to make a diagnosis. One of the most common ways to check for ulcers is with endoscopy (en-DOS-ko-pee). For this procedure, a person is given medication to relax and numb the throat. Then a doctor gently inserts an endoscope (a thin, flexible tube with a camera and light on the end) down the throat, through the esophagus, and into the stomach and intestines. The camera on the end of the endoscope allows the doctor to view the digestive system and take pictures of it. In addition, the doctor can perform a biopsy, removing a small amount of tissue for study under a microscope.
Although it is less helpful than endoscopy, another test that may be used to check for ulcers is an upper gastrointestinal * (GI) series. This is a set of x-rays of the gastrointestinal system. A person taking the test first drinks a white, chalky liquid called barium to help highlight the ulcer and make it visible on the x-ray.
A person suspected of having H. pylori infection may undergo a breath test. During a breath test, a person drinks a liquid containing a carbon marker known as carbon-13 (13C). The person then provides a breath sample by blowing up a balloon or blowing bubbles. The sample is checked for the presence of the 13C marker. If the person has H. pylori infection, there will be traces of 13C present in the carbon dioxide gas molecules of the person's breath. A person's blood also can be checked for the presence of antibodies * to H. pylori, indicating infection. However, the presence of the antibody in the blood does not indicate current infection and may be due to prior infection. Another diagnostic measure is to isolate H. pylori by taking a culture * of biopsy specimens of the stomach and/or duodenum. This is the most accurate means of detection.
People with peptic ulcers and infected with H. pylori are treated for 10 to 14 days with what is called triple therapy. This consists of a combination of two or three antibiotic medicines that kill H. pylori bacteria and a drug that reduces acid production in the stomach. But the mainstay of peptic ulcer treatment is the reduction or abolition of gastric acid secretion. Two classes of drugs reduce acid production: histamine type 2 receptor antagonists *
If left untreated, ulcers can lead to serious complications. In some cases, the ulcer can make a hole all the way through the stomach or duodenum wall. In other cases, the ulcer or acid breaks a blood vessel and causes serious internal bleeding. Peptic ulceration may obstruct the passage of stomach contents into the duodenum. It is important to get medical help promptly for the following symptoms, which may signal a peptic ulcer or other serious problem:
Ulcers that developed in response to medications such as NSAIDs or stressful situations such as severe burns and other conditions that are often associated with peptic ulcerations can be prevented by taking drugs known as prophylactic H2 blockers or proton pump inhibitors.
See also Bacterial Infections • Heartburn (Dyspepsia) • Helicobacter pylori Infection • Pancreatic Cancer • Stomach Cancer
Charisius, Hanno. “When Scientists Experiment on Themselves: H. pylori and Ulcers.” Scientific American. July 5, 2014. http://blogs.scientificamerican.com/guest-blog/when-scientistsexperiment-on-themselves-h-pylori-and-ulcers/ (accessed November 11, 2015).
American College of Gastroenterology. “Peptic Ulcer Disease.” http://patients.gi.org/topics/peptic-ulcer-disease (accessed November 11, 2015).
Centers for Disease Control and Prevention. “Helicobacter pylori and Peptic Ulcer Disease: The Key to Cure.” http://www.cdc.gov/ulcer/keytocure.htm (accessed November 11, 2015).
MedlinePlus. “Peptic Ulcer.” U.S. National Library of Medicine, National Institutes of Health. https://www.nlm.nih.gov/medlineplus/pepticulcer.html (accessed August 11, 2015).
National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health. “Peptic Ulcer Disease.” (accessed August 11, 2015).
American College of Gastroenterology. 6400 Goldsboro Rd., Suite 200, Bethesda, MD 20817. Telephone: 301-263-9000. Website: http://gi.org (accessed August 11, 2015).
American Gastroenterological Association. 4930 Del Ray Ave., Bethesda, MD 20814. Telephone: 301-654-2055. Website: http://www.gastro.org (accessed August 11, 2015).
Centers for Disease Control and Prevention. 1600 Clifton Rd., Atlanta, GA 30329-4027. Toll-free: 800-232-4636. Website: http://www.cdc.gov (accessed August 11, 2015).
National Institute of Diabetes and Digestive and Kidney Diseases. 9000 Rockville Pike, Bethesda, MD 20892. Telephone: 301-496-3583. Website: (accessed November 11, 2015).
* enzyme (EN-zime) is a protein that helps speed up a chemical reaction in cells or organisms.
* inflammation (in-fla-MAY-shun) is the body's reaction to irritation, infection, or injury that often involves swelling, pain, redness, and warmth.
* feces (FEE-seez) is the excreted waste from the gastrointestinal tract.
* gastrointestinal (gas-tro-in-TEStih-nuhl) means having to do with the organs of the digestive system, the system that processes food. It includes the mouth, esophagus, stomach, intestines, colon, and rectum and other organs involved in digestion, including the liver and pancreas.
* antibodies (AN-tih-bah-deez) are protein molecules produced by the body's immune system to help fight specific infections caused by microorganisms, such as bacteria and viruses.
* culture (KUL-chur) is a test in which a sample of fluid or tissue from the body is placed in a dish containing material that supports the growth of certain organisms. Typically, within days the organisms will grow and can be identified.
* antagonist (an-TAG-oh-nist) is a chemical that acts within the body to reduce or oppose the effects of another chemical.