• Peptic Ulcer

    (PUD; Duodenal Ulcer; Ulcer, Peptic; Ulcer, Duodenal)


    A peptic ulcer is a sore in the lining of the stomach or the first part of the small intestine. This area of the small intestine is called the duodenum. Peptic ulcers may be named by their location:
    Gastric Ulcer
    Copyright © Nucleus Medical Media, Inc.


    Upsets in the balance of stomach acid and digestive juices can lead to an ulcer. This can be caused by:
    • Helicobacter pylori ( H. pylori ) infection
    • Use of nonsteroidal anti-inflammatory drugs (NSAIDs)
    Less common causes include:

    Risk Factors

    Factors that may increase your chance of peptic ulcer include:
    • H. pylori infection
    • Taking NSAIDs for a long time and at higher doses
    • Prior peptic ulcer disease
    • Cigarette smoking
    • Alcohol use disorder


    Peptic ulcers do not always cause symptoms. Symptoms may come and go. Food or fluids sometimes make symptoms better. Having an empty stomach may make symptoms worse. However, symptoms can occur at any time.
    Symptoms may include:
      Gnawing pain:
      • May awaken you from sleep
      • May change when you eat
      • May last for a few minutes or several hours
      • Feels like unusually strong hunger pangs
      • May be relieved by taking antacids
    • Nausea
    • Vomiting
    • Loss of appetite
    • Bloating
    • Burping
    • Weight loss
    Ulcers can cause serious problems and severe abdominal pain. One problem is bleeding. Bleeding symptoms may include:
    • Bloody or black, tarry stools
    • Vomiting what looks like coffee grounds or blood
    • Weakness
    • Lightheadedness
    A perforated ulcer is a break through the wall of the stomach or duodenum. It causes sudden and severe pain.


    The doctor will ask about your symptoms and medical history. A physical exam will be done.
    Tests may include:


    Talk to your doctor about the best treatment plan for you. Treatment options may include one or more of the following:


    Your doctor may recommend:
    • Antibiotics if an infection is present or possible
    • Over-the-counter antacids
    • Proton pump inhibitors
    • H-2 blockers
    • Medications to coat ulcer
    • Medications to protect stomach against NSAID damage

    Lifestyle Changes

    You and your doctor will discuss lifestyle changes. These may include:
    • Quit smoking . Smoking worsens symptoms and slows healing.
    • Limit alcohol intake.
    • Avoid NSAIDs. This includes common over-the-counter drugs like aspirin and ibuprofen .

    Surgery and Endoscopy

    Surgery and/or endoscopy may be recommended for:
    • An ulcer that won't heal
    • Recurring ulcers
    • A bleeding ulcer
    • A perforated ulcer
    • Problems with food passing out of stomach
    This may be done to stop bleeding. A thin, lighted tube is inserted down the throat into the stomach or intestine. Heat, electricity, epinephrine, or a substance called fibrin glue can then be applied to the area. This should stop the blood flow.
    Surgery for peptic ulcers is rare, but it can greatly reduce acid production. Common procedures include:
    • Removal of the ulcer
    • Removal of part of the stomach or small intestine
    • Tying off the bleeding blood vessel
    • Taking tissue from another part of the intestine and oversewing the ulcer
    • Cutting part of the nerve that goes to the stomach to reduce acid production


    To help reduce your chance of H. pylori infection:
    • Wash your hands after using the bathroom and before eating or preparing food.
    • Drink water from a safe source.
    • Don't smoke . Cigarette smoking increases the chances of getting an ulcer.
    To help reduce your chance of a peptic ulcer from NSAIDs:
    • Use other drugs when possible for managing pain.
    • Take the lowest possible dose.
    • Don't take drugs longer than needed.
    • Don't drink alcohol while taking the drugs.
    • Ask your doctor about switching to medicines less likely to cause ulcers. Talk to your doctor about taking other drugs to protect your stomach and intestine lining.
    • Don't smoke. Cigarette smoking increases the chances of getting an ulcer.


    Gastro—American Gastroenterological Association http://www.gastro.org

    The American College of Gastroenterology http://patients.gi.org


    Canadian Association of Gastroenterology http://cag-acg.org

    Health Canada http://www.hc-sc.gc.ca


    Meurer LN, Bower DJ. Management of helicobacter pylori infection. Am Fam Physician. 2002;65(7):1327-1336.

    Peptic ulcer disease. American College of Gastroenterology website. Available at: http://patients.gi.org/topics/peptic-ulcer-disease. Accessed April 29, 2013.

    Peptic ulcer disease. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated April 22, 2013. Accessed April 29, 2013.

    Peptic ulcers and H. pylori. National Digestive Diseases Information Clearinghouse website. Available at: http://www.niddk.nih.gov/health-information/health-topics/digestive-diseases/peptic-ulcer/Documents/hpylori%5F508.pdf. Updated April 30, 2012. Accessed April 29, 2013.

    Understanding peptic ulcer disease. American Gastroenterological Association website. Available at: http://www.gastro.org/patient-center/digestive-conditions/peptic-ulcer-disease. Accessed April 29, 2013.

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